1. Data to Care Model Specification Date: _________ Health Department: _________________Program Name (if applicable): ________________ Problem statement: To link or re-engage PLWH reported to eHARS as of _ _/_ _/_ _ (“index date”) who are alive as of the index date, and with no CD4 or VL test for __ months before the index date. Step 6: Provide missing data located during investigation/outreach to surveillance Step 5: Conduct outreach and linkage or re-engagement activities Step 4: Share select data with field staff/providers to locate individuals on NIC list Step 3: Prioritize NIC list for follow-up and outreach Step 2: Investigate NIC list to complete missing data and verify care status Step 1: Generate output list from eHARS with key inclusion data for NIC list

2. Data to Care Model Specification Staff and role(s) responsible: Definition of NIC: Frequency list generated: Step 1: Surveillance generates NIC list. Staff and role(s) responsible: Other data sources used in matching: Step 2: Surveillance completes missing data by matching to other data sources. Staff and role(s) receiving list: How list is securely and confidentially shared: Sources used to verify status, including if providers are contacted: Where status/contact info is documented: Step 2: Surveillance shares list with _____ to verify care status and contact information through ________. Step 3

3. Data to Care Model Specification Staff and role(s) determining prioritization: How list is securely and confidentially shared with those prioritizing the list (if applicable): Prioritization criteria for outreach: Step 3: ____ prioritizes NIC list for follow up and outreach. Staff and role(s) receiving list: How list is securely/confidentially shared: Information on the NIC list and format of NIC list: Other data gathering needs post-sharing list: Surveillance staff and role(s) available to answer questions about the list: Step 4: _____ share NIC list with _______ for outreach. Staff and role(s) responsible for outreach: Supervisory structure of these positions: Linkage/re-engagement activities: If last known providers are contacted first: How outreach staff will connect with NIC: Parameters for reaching person: Step 5: Outreach by ____ to link or re- engage PLWH on NIC list. Step 6

4. Data to Care Model Specification Staff and role(s) responsible for documenting: What information/outcomes are collected: Where information is documented: How status/outcome is securely/confidentially maintained: How information is used: Step 6: Linkage or re- engagement status/outcome documented by _______ in _____. Staff and role(s) responsible for sharing information with surveillance: Staff and role(s) at surveillance receiving information: How information is securely/confidentially shared: What information is reported back: Step 6: Missing information located during investigation/outreach shared by ____ with surveillance.

5. Data to Care Model Specification – Providers Will providers participate in the HD’s DtC program? Which providers? All providers Subgroup of providers – which subgroups and what is the rationale? In what ways will providers participate? Confirming person NIC Confirming current address Confirming if appropriate for HD to follow up with person Confirming provider will follow up with person How will data be shared with providers? What information is shared with providers? Are data sharing agreements or MOUs needed? Who from the provider office will receive the information? Any special considerations about what information is shared with providers? Yes OrAnd/or And

6. Example from Los Angeles County, in+care Campaign presentation (available at: http://www.incarecampaign.org/files/85133/Linkage%20and%20Reengagement%20Programs%2003052014.pptx )http://www.incarecampaign.org/files/85133/Linkage%20and%20Reengagement%20Programs%2003052014.pptx