Forms for Monthly Perinatal HIV Reporting
The state of Illinois requires that all birthing and non-birthing hospitals in Illinois report monthly aggregate statistics on pregnant women and HIV testing.
Monthly Data Collection Record for Birthing Hospitals
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.
Monthly Data Collection Record for ED/Non-Birthing Hospitals
To be completed monthly by Illinois emergency department/non-birthing hospital staff detailing the number of pregnant women presenting, HIV documentation status, women delivering in the emergency department (ED), as well as pregnant or delivering women and newborns rapidly tested in the ED. This form is required by the state of Illinois.
*If you need a PDF Reader, please click the image link to the right.