Consent Form Hiv Test Page 9
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42Operating Procedure 153-31
June 14, 2010
(3)
Individual Unit Directors/designee will be responsible for the direction of the
resident HIV/AIDS education program in the respective units. All resident education will be
documented on the Immunization/Treatment Record--Communicable Diseases/Education Form
(Form 13). The Unit Level program will include a provision for entering resident education data
into the Computer Information System by the last day of each month.
(4)
Hospital Information Systems will furnish the Office of Quality Assessment and
Planning--Infection Control all resident HIV/AIDS Education data at the beginning of each
month.
(5)
Quality Assessment and Planning--Infection Control will monitor the HIV
counseling/testing program in conjunction with the Department of Health annually.
(Signed original on file in Central Health Information Services)
DIANE R. JAMES
11 Attachments
Hospital Administrator
1. Consent Form Confidential Human
Immunodeficiency Virus (HIV) Test
(Department of Health Form 1818, page
1)
2. Model Protocol on Counseling and
Testing for County Health Departments
and Registered Testing Programs
3. Statement of Objection to HIV/AIDS
Testing (Department of Health Form
3161)
4. Immunization/Treatment Record/
Communicable Diseases/Education Form
(Form 13)
5. Instruction Guide for HIV Testing/
Counseling
6. Management of Occupational Blood
Exposure to HBC, HCV or HIV
7. Resident/Employee Possible Blood/Body
Fluid Exposure Report (Form 180)
8. HIV/AIDS Educational Standards for
Residents
9. Florida Adult HIV/AIDS Confidential Case
Report (Form DH 2139) and Addendum
(DH 2134)
10. Case Definition for AIDS for Surveillance
Purposes
11. HIV/AIDS Lab Request (Form 1628) and
Instructions
9
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