Fillable Form HIV Test Result Form

What is an HIV Test Result Form?

An HIV Test Result Form is a document that discloses to the client the results of his or her HIV test. This form indicates whether or not the client has tested positive for HIV disease.

Can I fill out an HIV Test Result Form?

You can only fill out an HIV Test Result Form if you are authorized by a physician and if the client has successfully conducted their HIV test.

What do I need to fill out an HIV Test Result Form?

To fill out an HIV Test Result Form, you will need the name of your agency, the address of your agency, the client’s name/ID number, date of birth, sex, race, tester initials, name of the authorizing physician, and collection date.

You also require the results of the client’s HIV test as you will be inputting this in the HIV Test Result Form.

How do I fill out an HIV Test Result Form?

We will be guiding you through the process of filling out an HIV Test Result Form in this section.

Before filling out this form, please make sure that all information that you are about to input in this form is accurate. This is a form indicating someone’s HIV test results, and thus must be treated with the utmost care and professionalism.

Agency Details
In this section, you will need to indicate the details of your agency, namely the full name of the agency on the top line, and then followed by indicating the current address of the agency on the line below the name.

Client Details
In the following section, you will input the information regarding the client.

First, you need to indicate the client’s name or identification number. Next, you will need to indicate the client’s date of birth. Following their date of birth, you will be inputting the client’s sex. In the line below that, you must indicate the collection date or the date of conducting the HIV test. Following the date, you must also write down the client’s race. Finally for this line, indicate the tester’s initials.

Rapid HIV Antibody Test Result
In this section, you must indicate whether the results of the client’s Rapid HIV Antibody Test Result are either negative, positive, or invalid.

You must also indicate the type of specimen used for the Rapid HIV Antibody Test. Check the box indicating whether the test was conducted using a finger stick with whole blood or an Oral Fluid Specimen.

Below the test results is the meaning of each test result.

A non-reactive (negative) test result means no antibodies to HIV-1 have been detected. However, HIV antibodies may be absent during the “window period” of infection. Follow-up testing may be necessary if indicated by risk factors.

A reactive (preliminary positive) test result suggests that antibodies to HIV-1 may be present in the blood obtained from a rapid, finger stick test with whole blood. A specimen will have to be sent to a laboratory for a Western Blot test prior to confirmation of the reactive test result. Precautions should be taken to avoid the chance of spreading HIV.

An invalid test result running from a rapid finger stick can be due to a problem running the test or an interfering substance of the specimen. A specimen using any other technology should be collected and submitted to a laboratory for HIV testing.

If the client should have any questions, there is a section that indicates as well that they must contact the authorizing physician in order to address their queries.

Note that all information in this form has been disclosed from confidential records which are protected by state law. State law prohibits making any further disclosure of this information without the specific written consent of the person to whom it pertains, or as otherwise permitted by law.

After everything has been answered, congratulations, you have successfully completed the HIV Test Result Form.

What is HIV?

HIV stands for Human Immunodeficiency Virus which is a virus that attacks cells that help the body fight off infection, making a person who has HIV more vulnerable to other infections and diseases. People who are HIV-positive are sometimes called immunocompromised individuals.

HIV is most commonly spread through the shared contact of human bodily fluids during unprotected sex, which means either sex without a condom or HIV medicine to prevent or treat HIV. HIV spread can also occur through sharing injection drug equipment.

The human body is unable to naturally be rid of HIV. As there is also no known cure, a person who is HIV-positive will have the disease for the rest of their life. Despite this, there are treatment measures for HIV like antiretroviral therapy or ART. HIV-positive individuals can still live long and healthy lives while preventing the transmission of the disease to their sexual partners through this treatment.

However if left untreated, having HIV can lead to another disease called AIDS.

What are the symptoms of HIV?

There are several symptoms of HIV. Not everyone will have the same symptoms as these depend on the person and what stage of the disease they are currently in.

There are three stages of HIV, all of which have different symptoms.

Acute HIV Infection

This is the first stage of an HIV infection. People usually begin showing signs of infection within two to four weeks of infection. The disease normally manifests in flu-like symptoms which include but are not limited to:

• Fever
• Chills
• Rashes
• Night sweats
• Muscle aches
• Sore throat
• Fatigue
• Swollen lymph nodes
• Mouth ulcers

These symptoms may last anywhere from a day to several weeks. It is also important to note that some HIV-positive people may not experience these symptoms.

Clinical Latency
This is the second stage of an HIV infection. In this stage, the virus still multiplies but at lower levels. People in this stage may not feel sick or exhibit any of the previously mentioned symptoms. This stage is sometimes known as chronic HIV infection.

Without treatment, people can stay in this stage for up to 10 to 15 years, but some people may move through this stage faster than others.

AIDS
If you have HIV and are not on HIV treatment, eventually the virus will weaken your entire body’s immune system and you will progress to AIDS, which stands for acquired immunodeficiency syndrome. This is the last stage of HIV infection.

Symptoms of AIDS can include:

• Rapid weight loss
• Recurring fever or profuse night sweats
• Extreme or unexplained tiredness
• Prolonged swelling of the lymph glands in the armpits, groin, or neck
• Diarrhea that lasts for more than a week
• Sores of the mouth, anus, or genitals
• Pneumonia
• Red, brown, pink, or purplish blotches on ur under the skin and inside the mouth, nose, or eyelids
• Memory loss, depression, or other neurological disorders.