HIV - AIDS Reporting Requirements and Forms

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Our Location: 1221 Fulton Street
P O Box 11867, Fresno CA 93775-1867
Phone: (559) 600-3434
Hours of Operation: Monday - Friday 8:00 am - 5:00 pm

Program Overview

The FCDPH HIV/AIDS Surveillance Program monitors the timeliness and completeness of HIV/AIDS case reporting and in conjunction with CDPH/OA staff we work to improve the timeliness, accuracy, including mode of HIV transmission and reliability of local HIV/AIDS case data.

Federal and State laws require HIV/AIDS case reporting to be conducted by laboratories, local health departments, counseling and testing (C&T) sites and healthcare providers.

Per Title 17 - These forms are to be completed by all HIV Testing Providers:

HIV Reporting By Health Care Providers 2641.5-2643.20

Human Immunodeficiency Virus (HIV) infections is reportable by traceable mail or person-to-person transfer within seven calendar days by completion of the HIV/AIDS Case Report form (CDPH 8641A) available from the local health department.  For completing HIV-specific reporting requirements, see Title 17, CCR, 2641.30-2643.20 here

Due to the severe penalties written into the law for breaches in security and confidentiality, the Fresno County Department of Public Health, HIV Surveillance Program, strongly suggests you send the HIV/AIDS State case report forms and laboratory results indicative of HIV/AIDS by traceable mail or courier services only to:

Fresno County Department of Public Health
Attn:  Surveillance Program
1221 Fulton Mall, 5th Floor
Fresno, CA  93721
For questions call (559) 600-3434
Do NOT e-mail, fax, or send by first-class mail

HIV/AIDS Surveillance Case Reporting Forms

See above for instructions on how to send case reports

  • Adult HIV/AIDS Case Report Form (ACRF) Instructions
  • Adult HIV/AIDS Case Report Form
  • Pediatric HIV/AIDS Confidential Case Report
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    (If an adult or pediatric HIV/AIDS confidential case form is completed then the HIV Testing and Antiretroviral Use History form below must be completed and submitted to the local health department)

    California and State Laws on HIV/AIDS