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    DSHS HIV/STD Program

    Post Office Box 149347, MC 1873
    Austin, Texas 78714

    Phone: (512) 533-3000

    E-mail the HIV/STD Program

    E-mail data requests to HIV/STD Program

    DSHS strives to respond to all email requests in a timely manner. It is important to note, however, that messages that you send to us by email may not be secure and may be intercepted by a third party. Therefore, we recommend that you do not send any confidential health information to us by email.

Program Operating Procedures and Standards

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The Texas Department of State Health Services (DSHS), HIV/STD Program is pleased to provide the HIV and STD Program Operating Procedures and Standards manual. Please note that program and contract policies established by the HIV/STD Program are separate documents and are not incuded in the HIV and STD Program Operating Procedures manual except by reference.

 

Table of Contents

Chapter

Title

Last Updated

1

HIV/STI/HCV Testing, Counseling and Linkage to HIV Medical Care

4/2014

2

HIV/STI/HCV Testing and Linkage Documentation

4/2014

3

HIV/STI Partner Services and Seropositive Notification

4/2014

4

HIV Testing in STI Clinics

4/2014

5

Condom Promotion and Distribution

4/2014

6

Community Mobilization and Coordination for HIV Prevention

4/2014

7

HCV Testing

4/2014

8

HIV/STI Surveillance

-

9

Disease Intervention Specialists Performance Standards

11/2014

10

First-line Supervisors Performance Standards

1/2010

11

Regional and Local Health Department HIV/STD Program Manager Performance Standards

1/2010

12

STI Clinical Standards

12/2014

13

Administrative Agency Core Competencies

-

14

Client File Organization, Content and Security Standards

-

15

Client Referrals Standards

-

16

Food Services Standards

-

17

Health Insurance Program Standards

-

18

Pick-up and Delivery of Prescription and Over-The-Counter Medications Standards

-

19

Transportation Services Standards

-

20

Direct Client Services Volunteer Programs Standards

-

21

HIV Prevention Case Management

10/2008

C

Appendix C: TDCJ Memo (PDF : 75 kb)

-

E

Appendix E: STD*MIS System Maintenance

-

F

Appendix F: CDC Surveillance Case Definitions

-

G

Appendix G: HARS and STD Site Maps (PDF : 261 kb)

-

 

Forms

Form

Title

Last Updated

J-6

Disclosure and Consent Human Immunodeficiency Virus (HIV) Test (English)
(Word version : 17 kb | PDF version : 90 kb)

10/2007

J-6

Revelación y consentimiento para la prueba del virus de inmunodeficiencia humana (VIH)
(Word version 17 kb | PDF version 86 kb)

10/2007

L-30

Authorization to Release Confidential Information (English and Spanish) (PDF : 95 kb)

9/2004

L-36

General Consent and Disclosure (English and Spanish)
(Word version : 66 kb | PDF version : 79 kb)

4/2010

-

700 & 900 Case Management Audit Form
(Word version : 65 kb | PDF version : 24 kb)

12/2009

-

STD Patient Record Sample Form (Word : 79 kb)

11/2014

-

Express STD Services Model Assessment Form
(Word version : 21 kb | PDF version : 265 kb)

1/2015

-

Model Policy for Expedited STD Services
(Word version : 28 kb | PDF version :10 kb)

4/2010

-

Field Investigation Audit Form
(Word version : 65 kb | PDF version : 26 kb)

12/2009

-

Field Record (Pouch) Review/Audit Form
(Word version : 52 kb | PDF version : 25 kb)

12/2009

-

Interview Audit Form
(Word version : 68 kb | PDF version : 31 kb)

12/2009

STD-28

Notification of Laboratory Test Findings Indicating Presence of Chlamydia Trachomatis, Gonorrhea, Syphilis, Chancroid, HIV Infections or Suppressed CD4 Counts
(contact the program for more information)

-

STD-42

Disclosure and Consent Treatment for Sexually Transmitted Diseases by Injectible Medication (PDF : 48 kb)

-

STD-43

Risk Referral Form
(this duplicate form can be ordered by contacting the Program or calling (512) 533-3000)

-

 

The following HIV/STD forms can be ordered through the CDC STD Prevention website [CDC].

Project Area STD staff will need a User ID and Password to order field intervention forms. Contact your STD Program Manager or ICCR Clerk for information.

CDC Forms

  • Interview Record (CDC-7354)
  • Visual Case Analysis Sheet (CDC-7354D)
  • Field Record (CDC Form 29.36S) (CDC-73D)
  • Field Record (Work Copy) (CDC-73W)
  • Congenital Syphilis Case Investigation and Report (Instructions) (CDC-73.126)

Last updated May 12, 2015