Client County (3-digit FIPS code) PS15-1506 PrIDE Client ZIP Code PS15-1509 THRIVE PS19-1901 CDC STD PS17-1711 Other CDC funded PS18-1802 Other non-CDC funded Client Ethnicity Hispanic or Latino Not Hispanic or Latino Specify Other (optional) Client Race (select all that apply) American Indian/Alaska Native Asian Black/African American Native Hawaiian/Pacific Islander Agency Name or ID Site Name or ID Don t know Declined to Answer White Not Specified Declined to Answer Don t K.

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How to fill out the Luther Consulting HIV Test Template EvaluationWeb online

This guide provides detailed, step-by-step instructions on completing the Luther Consulting HIV Test Template EvaluationWeb online. Whether you are a first-time user or seeking clarification on specific sections, this comprehensive resource is designed to assist you in navigating the form easily and accurately.

Follow the steps to complete the HIV test template effectively.

  1. Click the ‘Get Form’ button to access the HIV Test Template and open it for editing.
  2. Begin by entering the agency and client information. This includes the session date, client state (using USPS abbreviation), program announcement, and client county (3-digit FIPS code). Ensure all fields marked as required are filled out completely.
  3. Proceed to the client demographics section, where you will select the client’s ethnicity and race. Options provided will allow you to specify categories that accurately reflect the client’s identity.
  4. Fill in the agency name or ID and site details, including ZIP code and county information. It is essential to capture accurate site type codes as specified in the guidelines.
  5. Complete the section regarding the client's assigned sex at birth and their current gender identity. Ensure to provide options accordingly and respect the terminology used by the client.
  6. Indicate whether the client has previously undergone an HIV test, and if so, include their year of birth. If unknown, enter '1800'.
  7. In the final test information section, specify the preferred HIV test election (anonymous or confidential). Include the test type and results if applicable. Each subfield requires careful consideration based on the client’s results.
  8. For clients testing positive, provide additional details such as attendance at medical appointments and the structured response for PrEP eligibility screenings. Include whether referrals were made and services offered.
  9. Review sections on housing status and any support services offered to the client. This includes insurance types and specifics about referrals given.
  10. After all information is entered, save changes to the form. Options to download, print, or share the form will be available depending on further actions required.

Complete your documents online today to ensure effective management and processing.

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