To be completed by Illinois hospital staff for every preliminary positve rapid HIV test result and faxed to the Mother and Child Alliance. This rapid HIV testing form is required by the state of Illinois.
| Attachment | Size |
|---|---|
| Preliminary Positive Data Collection Form (word)36.62 KB | 36.62 KB |
| Preliminary Positive Data Collection Form (pdf)80.31 KB | 80.31 KB |