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 their infant with identified institutions and... - Read More
New/Updated

Preliminary Positive Data Report

To be completed by Illinois hospital staff for every preliminary positive 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 HIV Viral Load Testing Requisition

The 24/7 Illinois Perinatal HIV Hotline facilitates expedited Viral Load tests (HIV-1 RNA assays) for calls to the Hotline in which an urgent viral load test result is needed for clinical decision making. Tests are performed at the Northwestern Memorial Hospital... - Read More

Rapid HIV Testing Monthly Report-Birthing Hospital

To be completed monthly by Illinois birthing hospital staff detailing the number of delivering people, HIV documentation status, and delivering patients 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 people presenting, HIV documentation status, patients delivering in the ED as well as pregnant or delivering people and newborns rapidly tested in... - Read More