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HIV/AIDS in Indiana > Clinical Data and Research > HIV/AIDS Confidential Case Reporting Forms HIV/AIDS Confidential Case Reporting Forms

Indiana State Department of Health Confidential Case Report Forms

NOTE: DO NOT FAX Case Report Forms; completed Case Report Forms should be mailed to:

Office of Clinical Data and Research
Indiana State Department of Health
2 N. Meridian St., 6-C
Indianapolis, IN 46204

ADULT FORM (>13 years of age at time of diagnosis)

PEDIATRIC FORM (<13 years of age at time of diagnosis)

Additional resources regarding reporting:

  • Communicable Disease Rule (PDF Format)
  • Link to Instructions for filling out an Adult Confidential Case Report form, and highlighting the new areas of the form:

Microsoft Powerpoint Presentation

OR

PDF Version

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