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Get NJ HIV Positive Tracking Form 2017-2021

_______________________________ First Test Site Counselor Name: __________________________ First Test Site Counselor Number: _______________ First Rapid HIV Test Type:  Determine  INSTI  Other Result: Positive HIV 1/2 Antibody  Positive HIV Antigen (Determine ONLY)  Specimen (circle one):  Oral  Venipuncture  Fingerstick Test Kit Lot Number: ________________ Positive ANTIGEN ONLY (Determine): No rapid tests can validate this result. Collect discordant work-up s.

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