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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 - This email can be used to request data and statistics on HIV, TB, and STDs in Texas. It cannot be used to get treatment or infection history for individuals, or to request information on programs and services. Please do not include any personal, identifying health information in your email such as HIV status, Date of Birth, Social Security Number, etc.

    For treatment/testing history, please contact your local Health Department.

    For information on HIV testing and services available to Persons Living with HIV and AIDS, please contact your local HIV services organization.

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

removed

-

17

Health Insurance Program Standards

-

18

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

-

19

removed

-

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 : 72 kb)

6/2015

-

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-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 July 15, 2015