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    Inform Consent HIV PDF

    Uploaded by

    Hartini
    1) The document is an informed consent form for HIV testing from the New York State Department of Health AIDS Institute. It details how HIV is transmitted and treatments available. 2) The form states that testing is voluntary, confidential, and can be done anonymously. Laws protect individuals from discrimination and services are available to help deal with consequences. 3) By signing, the patient agrees to HIV testing and future tests to guide treatment if positive. They can withdraw consent orally or in writing at any time. Future tests within the consent period only require notification, not re-signing.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Inform Consent HIV PDF

    Uploaded by

    Hartini
    465 views1 page
    1) The document is an informed consent form for HIV testing from the New York State Department of Health AIDS Institute. It details how HIV is transmitted and treatments available. 2) The form states that testing is voluntary, confidential, and can be done anonymously. Laws protect individuals from discrimination and services are available to help deal with consequences. 3) By signing, the patient agrees to HIV testing and future tests to guide treatment if positive. They can withdraw consent orally or in writing at any time. Future tests within the consent period only require notification, not re-signing.

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    Inform Consent HIV.pdf

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    1) The document is an informed consent form for HIV testing from the New York State Department of Health AIDS Institute. It details how HIV is transmitted and treatments available. 2) The form states that testing is voluntary, confidential, and can be done anonymously. Laws protect individuals from discrimination and services are available to help deal with consequences. 3) By signing, the patient agrees to HIV testing and future tests to guide treatment if positive. They can withdraw consent orally or in writing at any time. Future tests within the consent period only require notification, not re-signing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    465 views1 page

    Inform Consent HIV PDF

    Uploaded by

    Hartini
    1) The document is an informed consent form for HIV testing from the New York State Department of Health AIDS Institute. It details how HIV is transmitted and treatments available. 2) The form states that testing is voluntary, confidential, and can be done anonymously. Laws protect individuals from discrimination and services are available to help deal with consequences. 3) By signing, the patient agrees to HIV testing and future tests to guide treatment if positive. They can withdraw consent orally or in writing at any time. Future tests within the consent period only require notification, not re-signing.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    NEW YORK STATE DEPARTMENT OF HEALTH

    AIDS Institute HIV-Specific Model Consent Form

    Informed Consent to Perform HIV Testing

    My health care provider has answered any questions I have about HIV/AIDS. I have been provided information with the
    following details about HIV testing:
    • HIV is the virus that causes AIDS and can be transmitted through unprotected sex (vaginal, anal, or oral sex) with

    someone who has HIV; contact with blood as in sharing needles (piercing, tattooing, drug equipment including needles),

    by HIV-infected pregnant women to their infants during pregnancy or delivery, or while breast feeding.
    �
    • There are treatments for HIV/AIDS that can help an individual stay healthy.
    • Individuals with HIV/AIDS can adopt safe practices to protect uninfected and infected people in their lives from becoming

    infected or being infected themselves with different strains of HIV.


    �
    • Testing is voluntary and can be done anonymously at a public testing center.
    • The law protects the confidentiality of HIV test results and other related information.
    • The law prohibits discrimination based on an individual’s HIV status and services are available to help with such consequences.
    • The law allows an individual’s informed consent for HIV related testing to be valid for such testing until such consent is revoked
    by the subject of the HIV test or expires by its terms.

    I agree to be tested for HIV infection. If the results show I have HIV, I agree to additional testing which may occur on the sample I
    provide today to determine the best treatment for me and to help guide HIV prevention programs. I also agree to future tests to guide
    my treatment. I understand that I can withdraw my consent for future tests at any time. If I test positive for HIV infection, I understand
    that my health care provider will talk with me about telling my sex or needle-sharing partners of possible exposure.

    I may revoke my consent orally or in writing at any time. As long as this consent is in force, my provider may conduct additional tests
    without asking me to sign another consent form. In those cases, my provider will tell me if other HIV tests will be performed and will
    note this in my medical record.

    Patient Name: Date:

    Signature:
    Patient or person authorized to consent

    Medical Record #:

    DOH-2556 (1/11)

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