The HIV, STD and Viral Hepatitis Program - Forms

HIV:

• Testing
  • Model HIV Consent form for general patient use (Microsoft Word*) or (Adobe PDF*)
  • Model HIV Consent form for pregnant patients use (Microsoft Word*)  or (Adobe PDF*)
• Prevention
  • HIV Program Rider "A" (Microsoft Word*) or (Adobe PDF*)
  • Logic Model (Microsoft Word*) or (Adobe PDF*)
  • Logic Model Worksheet (Microsoft Word*) or (Adobe PDF*)
• Surveillance
  • Adult Case Report Forms (Adobe PDF*)
  • Pediatric Case Report Forms (Adobe PDF*)
• Care
  • ADAP Application (Adobe PDF*)
  • ADAP Release of Information (Adobe PDF*)
  • MaineCare Application (Adobe PDF*)
  • PHIP Application (Adobe PDF*)
  • Maine Rx Plus Application (Adobe PDF*)

STD

• STD Case Report (Microsoft Excel*) or (Adobe PDF*)

Contracting

• Division of Purchased Services Index