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    Informed Consent For Hiv Testing Doh-Nec Form A 2014

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    smoothp3ak
    This document provides information about informed consent for HIV testing in the Philippines. It explains that the Department of Health has a program to prevent and control HIV, and collects testing data to help stop the spread of HIV and support those diagnosed. The document outlines that HIV testing is voluntary, confidential, and involves taking a blood sample to test for HIV antibodies. It also notes that consent must be given to be tested, and test results will only be given to the individual tested.

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    Informed Consent For Hiv Testing Doh-Nec Form A 2014

    Uploaded by

    smoothp3ak
    80 views2 pages
    This document provides information about informed consent for HIV testing in the Philippines. It explains that the Department of Health has a program to prevent and control HIV, and collects testing data to help stop the spread of HIV and support those diagnosed. The document outlines that HIV testing is voluntary, confidential, and involves taking a blood sample to test for HIV antibodies. It also notes that consent must be given to be tested, and test results will only be given to the individual tested.

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    INFORMED CONSENT FOR HIV TESTING DOH-NEC FORM A 2014

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    This document provides information about informed consent for HIV testing in the Philippines. It explains that the Department of Health has a program to prevent and control HIV, and collects testing data to help stop the spread of HIV and support those diagnosed. The document outlines that HIV testing is voluntary, confidential, and involves taking a blood sample to test for HIV antibodies. It also notes that consent must be given to be tested, and test results will only be given to the individual tested.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    80 views2 pages

    Informed Consent For Hiv Testing Doh-Nec Form A 2014

    Uploaded by

    smoothp3ak
    This document provides information about informed consent for HIV testing in the Philippines. It explains that the Department of Health has a program to prevent and control HIV, and collects testing data to help stop the spread of HIV and support those diagnosed. The document outlines that HIV testing is voluntary, confidential, and involves taking a blood sample to test for HIV antibodies. It also notes that consent must be given to be tested, and test results will only be given to the individual tested.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    INFORMED CONSENT FOR HIV TESTING A

    The Department of Health (DOH) has an existing program for the prevention and control of the Human Immunodeficiency Virus (HIV) in the Philippines.
    The Epidemiology Bureau (EB) of DOH is mandated by Republic Act 8504 to collect information that will be used in planning activities to help stop the
    spread of HIV and to support and treat those diagnosed to have HIV. Your full cooperation is very important to this program. Please answer all
    questions as honestly as possible.

    ABOUT THE TEST


    1. What is HIV testing?
    An HIV test is a blood test. It will show if you have antibodies to HIV-- the virus that causes AIDS. A sample of blood will be taken from your arm. If the
    first test (screening) is reactive, another test (confirmatory) will be done to make sure that the first test is confirmed to be positive. A positive test
    means you have been infected with HIV, a negative test means you are probably not infected because it takes time for the body to produce antibodies.
    If you think you have been exposed recently, you need to be re-tested after 6 weeks to make sure you are not infected.
    2. Voluntary HIV testing
    Taking an HIV test is voluntary. Under Republic Act 8504, you cannot be tested without your knowledge and consent. If you do not want to be tested,
    you have the right to refuse the test.
    3. Confidentiality of Test Results
    Your test result is confidential. It will only be given to you personally.

     I was given information about HIV and HIV testing, and was given Name: _____________________________________
    the opportunity to ask questions during pretest counseling or
    group test information
     I agree to be tested for HIV. Signature: ________________ Date: ___________

    PERSONAL INFORMATION SHEET (FORM A)


    All information given will be STRICTLY CONFIDENTIAL. Please fill out this form COMPLETELY and as honestly as possible. Please write in
    CAPITAL LETTERS and CHECK the appropriate boxes.
    DEMOGRAPHIC DATA
    1 Philhealth Number:  Not enrolled in Philhealth
    Name (Full Name)
    2
    First Name Middle Name Last Name
    Mother’s Maiden Name (Full Real Name)
    3
    First Name Middle Name Last Name
    UNIQUE IDENTIFIER CODE
    First 2 letters of First 2 letters of
    Birth Order Month of Birth Day of Birth Year of Birth
    mother’s real name father’s real name
    4

    5 Age: Age in months (for less than 1 year old): Sex (at birth):  Male  Female
    Permanent Address:
    6 Current Place of Residence: Municipality/City: Province:
    Place of Birth: Municipality/City: Province:
    7 Contact Numbers: E-mail:
    8 Nationality:  Filipino  Others, please specify:
     None  Highschool  Vocational
    9 Highest Educational Attainment:
     Elementary  College  Post-Graduate
    10 Civil Status:  Single  Married Separated  Widowed
    11 Are you currently living with a partner?  No  Yes
    12 Number of Children Are you presently pregnant? (for females only)  No  Yes
    EMPLOMENT
    13 Current Occupation (Please specify main source of income):
    If no current work, what was previous occupation:
    14 Did you work overseas/abroad in the past 5 years?  No  Yes
    Month Year
    If Yes, when did you return from your last contract?
    Where were you based?  On a Ship  Land
    What country did you last work in?

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