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CTR Form B: Testing Information. Overview: Form B collects information about the testing and counseling services provided to a client. It is intended.

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Presentation on theme: "CTR Form B: Testing Information. Overview: Form B collects information about the testing and counseling services provided to a client. It is intended."— Presentation transcript:

1 CTR Form B: Testing Information

2 Overview: Form B collects information about the testing and counseling services provided to a client. It is intended to be used only by agency staff. Information is collected in three major categories: Pre-Test / Test Decision Counseling Testing Information (Rapid, Confirmatory, and/or Conventional) Post-Test Counseling / Other Activities The form can be used to collect both rapid and confirmatory testing data for a single client.

3 CTR Form B: Testing Information Form B Part 1 / 3

4 CTR Form B: Testing Information Form B Part 1 / 3 Test ID Sticker: Place the numbered Test ID sticker corresponding with the Client Questionnaire (Form A) that was completed by the client receiving testing services.

5 CTR Form B: Testing Information Form B Part 1 / 3 Site ID Number: The “Site ID Number” variable is not included on the EvaluationWeb website. Therefore, this is an optional field for agencies that enter their data directly into EvaluationWeb. Indicating your 4- digit Site ID Number is required for all agencies that forward their data forms to the WI AIDS/HIV Program for data entry.

6 CTR Form B: Testing Information Form B Part 1 / 3 Pre-Test Counselor ID Code: All testing staff at HIV testing sites must be registered with the WI AIDS/HIV Program, thereby receiving a four-digit Counselor ID code. Write the four-digit Counselor ID Code of the staff person conducting pre-test counseling activities in this field. Do not use another staff person’s Counselor ID Code. Please refer to the CTR Services Protocol for instructions on registering staff and obtaining Counselor ID Codes.

7 CTR Form B: Testing Information Form B Part 1 / 3 Test Sequence #: You do not need to complete this field of the form. The Test Sequence # refers to how many times a particular client’s Unique Client Code has been entered into EvaluationWeb. If the client has been tested previously and was entered into the EvaluationWeb system, the system will automatically generate the correct sequence number.

8 CTR Form B: Testing Information Form B Part 1 / 3 Testing Program: Select only one of the four options. Select the program that the client is being tested under. The majority of sites should select either the “CTR” or “PCRS” option. The Partner Elicitation option is limited to community organizations designated by the Wisconsin AIDS/HIV Program to offer persons testing positive the opportunity to provide information on their at-risk partners on site. The Social Networks option is limited to agencies designated to do social networks testing as part of their approved intervention plans. If the client is a “Network Associate” in the Social Networks program, check the Social Networks box, and enter the Unique Client Code of their “Recruiter” in the space provided.

9 CTR Form B: Testing Information Form B Part 1 / 3 Test Site Location: Nine options for Test Site Location are offered. Please select the one most appropriate option for a given testing event. Some sites will always provide testing at the same testing location (e.g. clinic). Other sites may provide some testing in agency and other testing at outreach events or other available locations. Choose the appropriate location for the specific client being tested.

10 CTR Form B: Testing Information Form B Part 1 / 3 How was the client tested this visit: Please select either Anonymous or Confidential. If the client was not provided either a rapid or conventional test, mark “Client not tested this visit,” and provide a brief reason. For example: testing deferred to a later date; client unable to provide informed consent due to intoxication; client referred to a different testing site; etc. If the client was not tested, you may skip down to the Other Activities section to document any other types of testing that may have been provided (pregnancy, STD, or hepatitis C). All other parts of Form B can be skipped if no HIV test was provided.

11 CTR Form B: Testing Information Form B Part 2 / 3 Rapid Testing Section: This section of Form B is used to document the rapid testing activities of a particular client. All agencies, regardless of whether they provide rapid testing, will need to complete the rapid testing fields. If an agency enters data directly into EvaluationWeb and does not provide rapid testing, the agency has the option of having system defaults set up so that rapid testing variables do not appear on the data entry screen. If the client had a non-reactive rapid test, or a reactive rapid but declined confirmation, all documentation of testing and post-test activities occurs in this section. The remainder of Form B (except the optional “Other Activities” section) can be skipped.

12 CTR Form B: Testing Information Form B Part 2 / 3 Rapid Test Type: Select one of the three options. If you did not provide a rapid test to the client, you must select “No rapid test administered.” Under “Lot #” and “Expiration Date” write the lot number and expiration date listed on the package of the rapid test you used for this client. Under Lot, only write the numbers – no letters.

13 CTR Form B: Testing Information Form B Part 2 / 3 Rapid Specimen Type: Select one of the four options. If you do not provide rapid testing, or no rapid test was administered for a particular client, please select “No rapid test administered.”

14 CTR Form B: Testing Information Form B Part 2 / 3 Rapid Result: Select one of the four options.

15 CTR Form B: Testing Information Form B Part 2 / 3 If Rapid Reactive… did client provide confirmatory sample? If the client was administered a rapid test and that test was reactive, select one of the three available options. It is not necessary to complete this field if any of the following apply: The client was provided a rapid test result and the result was negative; Your site does not provide rapid testing; or, Your site provides rapid testing, but no rapid test was administered for this particular client.

16 CTR Form B: Testing Information Form B Part 2 / 3 Was client given rapid test results? Select one of the three available options. If the client was not provided a rapid test, select the “No rapid test administered” option.

17 CTR Form B: Testing Information Form B Part 2 / 3 If no, please indicate reason: Select one of the three available options if the client received a rapid test, but did not receive their results. It is not necessary to complete this field if the client did not receive a rapid test.

18 CTR Form B: Testing Information Form B Part 2 / 3 Important Note: Only use the fields in this box for clients with non-reactive rapid tests, clients who declined confirmatory testing, or clients who did not receive their rapid result. If a client had a reactive rapid test, and was administered a confirmatory test, use the Confirmatory Post Test Counseling section of Form B.

19 CTR Form B: Testing Information Form B Part 2 / 3 Date of rapid post test counseling (mm/dd/yyyy): Indicate the date the client received their rapid test result.

20 CTR Form B: Testing Information Form B Part 2 / 3 Post-Test Counselor ID (four digits): Indicate the four-digit Counselor ID Code of the person who gave the client their rapid test result.

21 CTR Form B: Testing Information Form B Part 3 / 3 Conventional/Confirmatory Testing Section: This section of Form B is used to document confirmatory tests (following reactive rapids), and stand alone conventional tests (EIA / WB / PCR DNA). It also documents any post-test counseling that a client received following their conventional or confirmatory test. If no conventional or confirmatory test was provided, the counselor should only complete the “Was client given convent.test result?” question. “Other Activities,” including pregnancy testing, STD testing, etc. can still be documented if no conventional or confirmatory test was administered.

22 CTR Form B: Testing Information Form B Part 3 / 3 Conventional Test Specimen Type: Select one of the three options provided. The PCR DNA test option is limited to specific circumstances and requires prior authorization from the CTR Coordinator.

23 CTR Form B: Testing Information Form B Part 3 / 3 Conventional Test Result: Select one of the three options provided.

24 CTR Form B: Testing Information Form B Part 3 / 3 Was client given conventional test results? Select one of the three options provided.

25 CTR Form B: Testing Information Form B Part 3 / 3 If no, please indicate reason: Select one of the three options if the client received a conventional test, but did not receive their results. If checking “Other,” please specify a reason in the “Notes” section both on the paper form and in EvaluationWeb.

26 CTR Form B: Testing Information Form B Part 3 / 3 Date of conventional post test counseling (mm/dd/yyyy): Indicate the date the client received their conventional or confirmatory test result. Even if the client did not receive their result, EvaluationWeb requires a date to be entered. In this situation, enter the date that the client’s file was closed. The date of file closure must be within 45 days of the initial date of visit.

27 CTR Form B: Testing Information Form B Part 3 / 3 Post-Test Counselor ID (four digits): Indicate the four-digit Counselor ID Code of the person who gave the client their conventional/confirmatory test result.

28 CTR Form B: Testing Information Form B Part 3 / 3 Additional Post-Test Counseling Information The data system will not allow for post-test counseling information to be entered 45 days after the date of specimen collection. Agencies entering data directly into EvalutionWeb: After 45 days, the data system will automatically default to “Client did not return/Could not locate” option. If the client is located and test results are provided 45 days after specimen collection, notify the HIV CTR Coordinator and request that the client file be unlocked. This will allow you to enter post-test counseling information. Agencies submitting data forms to the AIDS/HIV Program for data entry: If a client has not returned for test results within 45 days of specimen collection and is lost to follow-up, please select the “Client did not return/Could not locate” option and submit the form as usual. If a client is located and test results are provided after you have submitted the form, please the HIV CTR Coordinator and provide the Unique Client Code, date results were provided, and Counselor ID code of the staff person who provided the results. The AIDS/HIV Program will update the record.

29 CTR Form B: Testing Information Form B Part 3 / 3 Activities: This section collects information on other activities that may have occurred during a pre- or post-test counseling session. This section should not be used to note either referrals to outside agencies for other testing services or testing that was provided outside a pre- or post-test counseling session. Skip these fields if the client did not engage in any of the listed activities. Three options are provided for additional testing: Pregnancy, STD, and Hepatitis C. Check the box that appropriately indicates the type of test and the time it was administered. The “Social Network Recruiter Orientation” box is for use by agencies with authorized Social Networks interventions. Checking this box will indicate that the client has been enrolled as a “Recruiter.”

30 CTR Form B: Testing Information Form B Part 3 / 3 Notes: Use this section to explain any unusual circumstances, such as: 1) reason the client declined conventional testing after a reactive rapid, 2) confirmatory testing obtained from an outside source, 3)circumstances surrounding why a client hasn’t received their test results, and 4) reason for no referrals listed when a client tests positive.


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