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Indiana State Department of Health
Indiana State Department of Health
HIV/AIDS in Indiana > Clinical Data and Research > HIV/AIDS Confidential Case Reporting Forms HIV/AIDS Confidential Case Reporting Forms
Indiana State Department of Health Confidential Case Report Forms
NOTE: DO NOT FAX Case Report Forms; completed Case Report Forms should be mailed to:
Office of Clinical Data and Research
Indiana State Department of Health
2 N. Meridian St., 6-C
Indianapolis, IN 46204
SF51201 ADULT HIV/AIDS CONFIDENTIAL CASE REPORT (>13 years of age at time of diagnosis)
SF51202 PEDIATRIC HIV/AIDS CONFIDENTIAL CASE REPORT (<13 years of age at time of diagnosis)
SF54730 PERINATAL EXPOSURE CONFIDENTIAL REPORT FOR CHILDREN BORN TO MOTHERS WITH HIV INFECTION
Instructions for completing the Indiana HIV Case Report form: (PDF Format)
These forms may be used any time but they are required on all reports made after January 15, 2013
Additional resources regarding reporting:
- Communicable Disease Rule (PDF Format)
