Counseling, Testing, and Referral Program

The following policies, procedures and program forms are applicable to all contracted counseling, testing, and referral (CTR) sites receiving reimbursement through the North Dakota Department of Health for HIV testing activities. These policies may or may not be applicable to other agencies involved in HIV testing.

Policies and Procedures

CTR Policy Manual (Revised 3/2009)

Guidelines for Viral Hepatitis CTR Services (Revised 4/2011)

Forms

• Instructions for use of CTR Forms (Revised 10/2009)
• Informed Consent for HIV Testing (Revised 04/2008)
• SFN 58942 STI/HIV/Hepatitis Risk Assessment & Reduction Plan (Revised 02/2008)
• SFN 58941 Counseling Assessment for HIV Testing (Revised 04/2009)
• Clearview complete Rapid HIV Test Result Form (Revised 10/2009)
• Client Satisfaction Survey (Revised 08/2008)
• SFN 59072 Clearview Complete Reactive/Nonreactive Control Log (Revised 10/2009)
• SFN 59093 Fahrenheit Temperature Log (Revised 03/2009)
• SFN 59092 Celsius Temperature Log (Revised 03/2009)
• Emergency Relocation Plan Template
• "Do Not Unplug" Warning Signs
• CDC HIV Test Form - All Parts
All data submitted must be on original blue carbon form. Copies will not be accepted. To order more forms use the Prevention supply order form below.

Ordering Prevention Supplies

Please allow 1-2 weeks for delivery of prevention materials. Rapid tests will take longer, so allow 3-4 weeks when ordering these. Include your name since multiple orders may be received from your agency. Call 701.328.2376 if you have any questions.

Mail or fax your order to RJ Jansen at:
2635 E. Main Avenue
Bismarck, ND 58506-5520
Fax 701.328.2499

SFN 52281 HIV Prevention Supplies & Information Order Form (Revised 05/2012)

Request for Reimbursement

Please submit monthly reimbursement via email to the HIV program manager, Krissie Guerard at kguerard@nd.gov. Call 701.328.4555 if you have any questions regarding the reimbursement.

SFN 8684 Request for HIV Prevention Reimbursement Form (Revised 05/2012)

CDC Guidelines

2006 Revised Recommendation for HIV Testing, Adults, Adolescents, and Pregnant Women in Health-Care Settings

Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HIV and Recommendations for Postexposure Prophylaxis

Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States

Laws

For more information on North Dakota Century codes visit http://www.legis.nd.gov

• NDCC 14-10       Minors
• NDCC 23-01.3    Health Information Protection
• NDCC 23-07       Reportable Diseases
• NDCC 23-07.4    Human Immunodeficiency Virus Infection Health Procedures
• NDCC 23-07.5    Bloodborne Pathogen Testing
• NDCC 23-07.6    Communicable Disease Confinement Procedure
• NDCC 23-07.7    Court-Ordered Testing for STDs
• NDCC 33-06       Reportable Conditions
• NDCC 33-06-04   Control of Specific Diseases
• NDCC 45-03-11   Notice, Consent, and Disclosure for Testing of Blood or Other Bodily Fluids

Testing Resources

Counseling

Table of Suggested Open Ended Questions

Counseling protocols and counselor prompt cards can be downloaded at:

Centers for Disease Control and Prevention HIV Counseling
http://www.cdc.gov/hiv/topics/research/respect-2/counseling/index.htm

Conventional Testing

OraSure Testing

• Patient Information Pamphlet
• OraSure HIV-1 MSDS Preservative Solution
• OraSure HIV-1 MSDS Collection Pad

Rapid Testing

Clearview Complete HIV 1/2

• Clearview Complete Brochure
• Clearview Complete Quick Reference Card
• Clearview HIV 1/2 Complete Package Insert
• Clearview Complete Controls Package Insert
• Clearview Complete MSDS for Controls
• Clearview Complete MSDS for Test Kits

Centers for Disease Control and Prevention (CDC) Rapid HIV Testing
http://www.cdc.gov/hiv/topics/testing/rapid/index.htm

Copyright © 2009 North Dakota Department of Health

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