Get Testing And Treatment History Questionnaire Medicine History - Scdhec

This guide provides clear and detailed instructions on how to fill out the Testing And Treatment History Questionnaire Medicine History - Scdhec online. By following these steps, you can ensure that your information is accurately documented for necessary HIV surveillance.

Follow the steps to successfully complete the questionnaire.

1. Begin by clicking the ‘Get Form’ button to access the questionnaire and open it in the editor.
2. Fill in the date when the information was collected in the first field labeled 'Date Information collected'.
3. Provide your name in the 'Patient Name' field. Ensure it is written clearly.
4. Select the main source of information regarding your testing and treatment history. You can choose from the options provided: Patient Interview, Medical Record Review, Provider Report, PEMS, or Other.
5. Respond to question #3 regarding any previous positive tests. If you have had a positive test, mark 'Yes' and provide the date of your first positive HIV test in the specified field. If not, you may mark 'No' or any of the other options.
6. Indicate whether you have ever had a negative test for HIV in question #4. If 'Yes', please provide the date of your last negative test.
7. In question #5, record the number of negative HIV tests you had within 24 months prior to your first positive test.
8. For question #6, indicate if you have ever taken any Antiretroviral (ARV) medications. If 'Yes', proceed to detail which ARV medications you took and the dates you began and last took them.
9. Confirm if you are currently taking any ARVs in question #6d. Provide the relevant responses as applicable.
10. Finally, ensure that your name is included in the section for the person completing the form, and review your entries for accuracy.
11. Once completed, save your changes, and download or print the document as required. You may also share the form with the designated department.

Complete your questionnaire online to support vital HIV surveillance efforts.