Confidential HIV/AIDS Case Report Forms

Indiana Department of Health Confidential Case Report Forms

D NOT Fax case report forms. Completed case report forms should be mailed to:

Office of Clinical Data and Research
Indiana Department of Health
2 N. Meridian St., 6-C
Indianapolis, IN 46204

Adult form (>13 years of age at time of diagnosis)

Pediatric form (<13 years of age at time of diagnosis)

Additional resources regarding reporting:

Microsoft Powerpoint Presentation

OR

PDF Version