Hiv Counseling Information Form Page 3
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3State of California—Health and Human Services Agency
California Department of Public Health
RACE / ETHNICITY CODES
Asian:
313 Laotian
Native Hawaiian/Pacific Islander:
Hispanic/Latino(a):
301 Asian Indian
324 Madagascar
422 Guamanian
505 Caribbean
302 Bangladeshi
314 Malaysian
411 Hawaiian
503 Central American
303 Bhutanese
321 Maldivian
403 Melanesian
507 Cuban
304 Burmese
322 Nepalese
402 Micronesian
502 Mexican
305 Cambodian
315 Okinawan
401 Polynesian
506 Puerto Rican
306 Chinese
316 Pakistani
412 Samoan
504 South American
308 Filipino
323 Singaporean
404 Other Pacific Islander
501 Spaniard
309 Hmong
317 Sri Lankan
599 Other Latino
310 Indonesian
307 Taiwanese
320 Iwo Jiman
318 Thai
311 Japanese
319 Vietnamese
312 Korean
399 Other Asian
CALIFORNIA COUNTY CODES
1 Alameda
13 Imperial
25 Modoc
37 San Diego
49 Sonoma
2 Alpine
14 Inyo
26 Mono
38 San Francisco
50 Stanislaus
3 Amador
15 Kern
27 Monterey
39 San Joaquin
51 Sutter
4 Butte
16 Kings
28 Napa
40 San Luis Obispo
52 Tehama
5 Calaveras
17 Lake
29 Nevada
41 San Mateo
53 Trinity
6 Colusa
18 Lassen
30 Orange
42 Santa Barbara
54 Tulare
7 Contra Costa
19 Los Angeles
31 Placer
43 Santa Clara
55 Tuolumne
8 Del Norte
20 Madera
32 Plumas
44 Santa Cruz
56 Ventura
9 El Dorado
21 Marin
33 Riverside
45 Shasta
57 Yolo
10 Fresno
22 Mariposa
34 Sacramento
46 Sierra
58 Yuba
11 Glenn
23 Mendocino
35 San Benito
47 Siskiyou
12 Humboldt
24 Merced
36 San Bernardino
48 Solano
STATE/TERRITORY CODES
FM Federated States of
AL Alabama
IL Illinois
MT Montana
RI Rhode Island
Micronesia
AK Alaska
IN Indiana
NE Nebraska
SC South Carolina
GU Guam
AZ Arizona
IA Iowa
NV Nevada
SD South Dakota
MH Marshall Islands
AR Arkansas
KS Kansas
NH New Hampshire
TN Tennessee
MP Northern Mariana Islands
CA California
KY Kentucky
NJ New Jersey
TX Texas
PW Palau
CO Colorado
LA Louisiana
NM New Mexico
UT Utah
PR Puerto Rico
CT Connecticut
ME Maine
NY New York
VT Vermont
VI Virgin Islands of the U.S.
DE Delaware
MD Maryland
NC North Carolina
VA Virginia
88 Client does not currently
DC District of Columbia
MA Massachusetts
ND North Dakota
WA Washington
reside in a US state,
territory, or district.
FL Florida
MI Michigan
OH Ohio
WV West Virginia
GA Georgia
MN Minnesota
OK Oklahoma
WI Wisconsin
HI Hawaii
MS Mississippi
OR Oregon
WY Wyoming
ID Idaho
MO Missouri
PA Pennsylvania
AS American Samoa
ANTIRETROVIRAL (ARV) MEDICATION CODES
22 Agenerase (amprenavir)
18 Invirase (saquinavir, SQV)
13 Trizivir (abacavir/lamivudine/zidovudine,
ABC/3TC,AZT)
30 Aptivus (tipranavir, TPV)
34 Intelence (etravirine)
27 Truvada (tenofovir DF/emtricitabine, TDF/FTC)
32 Atripla (efavirenz/emtricitabine/tenofovir DF)
36 Isentress (raltegravir)
01 Videx (didanosine, ddl)
24 Combivir (lamivudine/ zidovudine, 3TC/AZT)
16 Kaletra (lopinavir/ ritonavir)
14 Videx EC (didanosine, ddl)
06 Crixivan (indinavir, IDV)
31 Lexiva (fosamprenavir, 908)
17 Viracept (nelfinavir, NFV)
11 Emtriva (emtricitabine, FTC)
07 Norvir (ritonavir, RTV)
05 Viramune (nevirapine, NVP)
03 Epivir (lamivudine, 3TC)
33 Prezista (darunavir, DRV)
12 Viread (tenofovir DF, TDF)
28 Epzicom (abacavir/lamivudine, ABC/3TC)
09 Rescriptor (delavirdine, DLV)
04 Zerit (stavudine, d4T)
25 Fortovase (saquinavir, SQV)
26 Retrovir (zidovudine, ZDV, AZT)
20 Ziagen (abacavir, ABC)
10 Fuzeon (enfuvirtide, T20)
15 Reyataz (atazanavir, ATV)
88 Other Antiretroviral
19 Hepsera (adefovir)
08 Saquinavir (Fortavase, Invirase)
99 Unspecified
02 Hivid (zalcitabine, ddC)
35 Selzentry (maraviroc)
23 Hydroxyurea
21 Sustiva (efavirenz, EFV)
CDPH 8458 (07/14)
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