Resources & Forms
Hotline Release of Information 
To be used by providers to link their patients to case management and specialty care. Once signed by the patient, the release of information authorizes the Hotline to receive and share information about the patient and exposed infant with identified institutions and... - Read More
Preliminary Positive Data Report
To be completed by Illinois hospital staff for every preliminary positve rapid HIV test result and faxed to the Mother and Child Alliance (formerly Pediatric AIDS Chicago Prevention Initiative). This form is required by the state of Illinois.
Expedited Confirmatory HIV Testing Requisition
The 24/7 Illinois Perinatal HIV Hotline offers expedited confirmatory HIV testing at Northwestern Memorial Hospital’s Immunology Laboratory for calls to the Hotline in which an urgent confirmatory HIV test result is needed for clinical decision making.The specimens are... - Read More
Expedited Newborn HIV-1 DNA PCR Testing Requisition
The 24/7 Illinois Perinatal HIV Hotline offers expedited HIV-1 DNA PCR tests for calls to the Hotline in which an urgent test result is needed for pediatric treatment decision making. Specimens are processed at the Special Infectious Disease (SID) Laboratory of the Ann... - Read More
Rapid HIV Testing Monthly Report-Birthing Hospital
To be completed monthly by Illinois birthing hospital staff detailing the number of delivering women, HIV documentation status, and women and newborns rapidly tested in labor and delivery. This form is required by the state of Illinois.
Rapid HIV Testing Monthly Report-Non Birthing Hospital
To be completed monthly by Illinois emergency department (ED)/non-birthing hospital staff detailing the number of pregnant women presenting, HIV documentation status, women delivering in the ED as well as pregnant or delivering women and newborns rapidly tested in the ED... - Read More
