Forms

Forms

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Category: Resources
Hits: 27438
 

{slider Forms for EIMS outage}

Published Year Title PDF Format
2025 Patient Registration Form [ PDF - 74 KB ]
2025 STI Clinic Form [ PDF - 74 KB ]
2025 Prescription to pharmacy/injection room [ PDF - 87 KB ]
2025 Medical record for PEP/PEPSE
 [ PDF - 128 KB ]
2025 Medical record for PrEP [ PDF - 109 KB ]
 

{slider Minimal paper documentation in HIV clinics in addition to EIMS}

Published Year Title PDF Format
2025 ART Medical record 1st visit [ PDF - 294 KB ]
2025 ART Medical record follow up visits [ PDF - 507 KB ]

{slider STD Reporting formats}

Published Year Title PDF Format Editable Format
2024 Quarterly STD Return-version 31.01.2024 [ PDF - 1049 KB ]  
2023 Quarterly STD Return-version 15.05.2023 [ PDF - 444 KB ]  
2022 Quarterly STD Return – version 25.04.2022 [ PDF - 497 KB ]  
2017 Quarterly STD Return – version 29.05.2017 (not in use after Q4-2021) [ PDF - 453 KB ] [ DOC - 236 KB ]
2017 HIV Confirmatory  Request & Strategic Information Form 7.4.2017 [ PDF - 172 KB ]
2016 Data on Pregnancy & Sexually Transmitted Infections [ PDF - 270 KB ] [ DOC - 42 KB ]
2016 Report of the outreach blood screening programme for Prisoners [ PDF - 178 KB ] [ DOC - 36 KB ]
2011 HIV & STI Among MARPS Escorted to the STD Clinic [ PDF - 267 KB ] [ DOC - 33 KB ]
2011 Quarterly return - STI Laboratory - Version 12.12.011 [ PDF - 18 KB ] [ DOC - 42 KB ]
 

{slider STD Recording formats}

Published Year Title PDF Format Editable Format
       2016 Main Register Format 2016.12.07 [ PDF - 420 KB ] [ XLS - 40 KB ]
       2016 Subsequent Visit Register Format [ PDF - 321 KB ]  
       2016 Microscopist daily Register 2016.08.02 [ PDF - 195 KB ]
       2016 Routine OPD Blood Examination Register [ PDF - 189 KB ] [ XLS - 33 KB ]
       2016 IEC/Awareness Programme Register [ PDF - 191 KB ]
       2011 Form for Strategic Info on Lab confirmed HIV infections 06.07.2011 [ PDF - 152 KB ] [ DOC - 83 KB ]
       2010 Male clinic form (PIMS) - Version 14102010 [ PDF - 283 KB ] [ DOC - 188 KB ]
       2010 Female clinic form (PIMS) - Version 14102010 [ PDF - 270 KB ] [ DOC - 203 KB ]
 

{slider ART Reporting formats}

Published Year Title PDF Format Editable Format
2017 Quarterly return from HIV care/ART center –version 29.05.2017 [ PDF - 276 KB ] [DOC-154KB] 
 

{slider ART Recording formats}

Published Year Title PDF Format Editable Format
       2017 ART Card-2017.03.31 [ PDF - 785 KB ]  
       2016 Antiretroviral Drug Dispensing Register-2016.08.03 [ PDF - 219 KB ]  
       2016 Pre-ART Register [ PDF - 168 KB ] [ DOC - 146 KB ]
       2016 ART Register [ PDF - 253 KB ] [ XLS - 36 KB ]
 

{slider EMTCT Formats and Tools}

Title PDF Format
Hepatitis Case Investigation Form [PDF - 1.06MB ]
EMTCT HIV Case Investigation form [PDF - 587 KB ]
EMTCT Syphilis case investigation form [PDF - 585 KB ]
EMTCT Hepatitis B: Case Investigation Form [PDF - 347 KB ]
EMTCT HIV-STD Clinic Supervision Checklist EMTCT HV 11.2018 [PDF - 293 KB ]
EMTCT Syphilis-STD Clinic Supervision Checklist EMTCT HV 11.2018 [PDF - 255 KB ]
STD Clinic supervision report [PDF - 226 KB ]
Data-assessment tool Global amended 29 March 2018 [PDF - 1.34 MB]
HR GE CE assessment tool [PDF - 177 KB ]
Laboratory assessment [PDF - 1.6 MB ] 
Program assessment tool EMTCT 2018 [PDF - 926 KB ]
Postnatal survey format [PDF - 521 KB ]
 

{slider KP monitoring formats}

Title PDF Format Editable Format
HIVST Stock Management Register by STD clinic [PDF - 116KB] [DOC - 27KB]
Unique Identifier Code (UIC) - Sinhala [PDF - 950KB]  
Unique Identifier Code (UIC) - Tamil [PDF - 328KB]  
Client Registration Form (Version 10.1.2020) - Sinhala [PDF - 247KB]
Clinic Escort, Referral for H - Sinhala [PDF - 255KB]
  
PE Daily record form (Peer-led mod) - Sinhala [PDF - 175KB]
  
Generating the new UIC 10.3.2020 - Sinhala [PDF - 295KB]
  
Client Registration Form - Tamil [PDF - 244KB] [DOC - 60KB]
Refreal Form - Tamil [PDF - 201KB] [DOC -66KB]
PE Daily Record Form - Tamil [PDF - 177KB] [DOC -49KB]
Outreach Rapid HIV Test Result Form   [PDF - 121KB] [DOC - 62KB]
Condom Stock Management Form (Version 10.1.2020) [PDF -255KB]  [DOC - 75KB] 
KP Prevention Reporting Format (Version 10.1.2020)  [PDF - 145KB] [DOC - 46KB]
Data Collection and Reporting Guidelines (For KP Prevention Programme implemented by NSACP)  [PDF -222KB]  [DOC - 90KB] 
Summary - Primary Forms for KP Prevention programme  [PDF - 107KB]  [DOC - 34KB]
 

{slider Other formats}

Title PDF Format Editable Format

{/sliders}

Quarterly return from HIV care/ART centre –version 29.05.2017

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