Kentucky Hiv Test Form Page 5

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KENTUCKY HIV TEST FORM
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State and U.S. Territory Abbreviations
AL
Alabama
MI
Michigan
TX
Texas
AK
Alaska
MN
Minnesota
UT
Utah
AZ
Arizona
MS
Mississippi
VT
Vermont
AR
Arkansas
MO
Missouri
VA
Virginia
CA
California
MT
Montana
WA
Washington
CO
Colorado
NE
Nebraska
WV
West Virginia
CT
Connecticut
NV
Nevada
WI
Wisconsin
DE
Delaware
NH
New Hampshire
WY
Wyoming
FL
Florida
NJ
New Jersey
GA
Georgia
NM
New Mexico
HI
Hawaii
NY
New York
ID
Idaho
NC
North Carolina
IL
Illinois
ND
North Dakota
AS
American Samoa
IN
Indiana
OH
Ohio
DC
District of Columbia
IA
Iowa
OK
Oklahoma
FM
Federated States of Micronesia
KS
Kansas
OR
Oregon
GU
Guam
KY
Kentucky
PA
Pennsylvania
MH
Marshall Islands
LA
Louisiana
RI
Rhode Island
MP
Northern Mariana Islands
ME
Maine
SC
South Carolina
PW
Palau
MD
Maryland
SD
South Dakota
PR
Puerto Rico
MA
Massachusetts
TN
Tennessee
VI
Virgin Islands
Site IDs and Names
If you need to know your Site ID number, you may contact the HIV/AIDS Branch at 800-420-7431.
Disease Reporting to HIV/AIDS Surveillance Branch
1.
Report either by phone or mail; do not fax any confidential information
2.
When mailing, please place case forms inside of two (2) sealed envelopes, both marked “CONFIDENTIAL”
Adult and Adolescents Reporting Form is for ages ≥13, the Pediatrics Reporting Form is for ages <13
3.
4.
Blank forms can be obtained by visiting
Reports from Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer and Trimble Counties:
Phone: Nichelle Anderson at 502-574-6574
Mail: Louisville Metro Health Department
Attn: Nichelle Anderson
400 East Gray St., Rm 317
Louisville, KY 40202
Reports from all other 113 Kentucky Counties:
Phone: Julie Nakayima or Julie Kauzlarich at 866-510-0008 or 502-564-0536
Mail: Kentucky Department for Public Health
Attn: Julie Nakayima
275 E. Main Street, HS2E-C
Frankfort, KY 40621
Additional information on the state regulation regarding reporting is available at

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