Contact Tracing Form

Questions	Concepts
Contact Date ␣␣-␣␣-␣␣␣␣ 📆
Contact Method 🔘 Physical contact/client tracing 🔘 Telephone contact/client tracing 🔘 Other non-coded
Contacted Successfully 🔘 Yes 🔘 No 🔘 Unknown
Outcome 🔘 Contact came for HTS 🔘 Contact will test elsewhere 🔘 Refused Test 🔘 Partner confirmed HIV+
Contact booked for HIV test 🔘 Yes 🔘 No 🔘 Unknown
Date booked for HIV test ␣␣-␣␣-␣␣␣␣ 📆
Contact Tested for HIV 🔘 Yes 🔘 No 🔘 Unknown
Contact HIV Status 🔘 Positive 🔘 Negative 🔘 Indeterminate 🔘 Unknown
Outcome
Final Outcome reached (After successful or multiple unsuccessful tracing attempts) 🔘 Yes 🔘 No
Final outcome contact tracking 🔘 Partner HIV tested 🔘 Partner confirmed HIV+ 🔘 Will test elsewhere 🔘 Contact is far from this facility 🔘 Contact unwilling to come 🔘 Dead 🔘 Unsuccessful
Notes __________________________________