Browsers that can not handle javascript will not be able to access some features of this site.
Skip Navigation
Michigan Department of Community HealthMichigan.gov, Official Website for the State of Michigan
Michigan.gov HomeMDCH Home | Sitemap | Contact MDCH
Printer Friendly Version Printer Friendly   Text Only Version Text Version  Share this page.
HIV Forms

• HIV/AIDS Adult Case Report Form - ADULT FORM PDF icon
Updated May 2010

• HIV/AIDS Adult Case Report Form - ADULT INSTRUCTIONS PDF icon
Updated May 2010

• MDSS HIV/AIDS Adult Case Report Form - ADULT INSTRUCTIONS PDF icon
Updated May 2012

• HIV/AIDS Pediatric Case Report Form - PEDIATRIC FORM PDF icon
Updated October 2010

• HIV/AIDS Pediatric Case Report Form - PEDIATRIC INSTRUCTIONS PDF icon
Updated April 2011

• HIV Reporting Information for Health and Life Insurance Companies
Click here for guidance, approved reporting forms, and MDCH contact information

• Confidential Request Form for Local Health Department Assistance for Partner Counseling & Referral Services (DCH-1221) - FORM PDF icon

• Confidential Request for Local Health Department Assistance for Partner Counseling & Referral Services (DCH-1221) - INSTRUCTIONS PDF icon

• Verification Regarding Test Results (Court-Ordered Testing DCH-1252) PDF icon

• Victim Authorization Regarding Notification of Test Results Form (Court-Ordered Testing DCH-1253) PDF icon

• Instructions for Completing Verification Regarding Test Results Form PDF icon

• Officer/Employee Request for HIV, Hepatitis B and/or Hepatitis C Testing of Arrestee, Correctional Facility Inmate, Parolee or Probationer (DCH-1169[E]) PDF icon

• Policy and Procedure - Requests for Letters of Support for External Partners, April 2010 PDF icon

• First Responder Provider Request for HIV/AIDS and/or Hepatitis B Testing of Emergency Patient (DCH-1179[E]) PDF icon

• Sample Form - HIV Test Consent PDF icon

• Sample Form - Consent to Treatment - Spanish Version PDF icon

• Sample Form - Consent to Treatment - Arabic Version PDF icon







Michigan Business One Stop
Link to Department and Agencies Web Site Index
Link to Statewide Online Services Index
Link to Statewide Web-based Surveys
Link to RSS feeds available on this site
Quick Links
 •  News Releases
 •  MDCH Brochures Available for Download
 •  Careers & Internships
 •  Finding Free or Low-Cost Health Care
 •  Health Information Technology (HIT) Commission
 •  Long-Term Care Commission
 •  Informed Consent for Abortion
 •  Find Shortcuts to MDCH Web Topics
 •  Might I be eligible for benefits? Click here to find out
 •  GENDIS - Genealogical Data
 •  Consent Options for Use of New/Archived Dried Blood Spots

Michigan.gov Home | Office of Regulatory Reinvention | MDCH Home | Contact MDCH | State Web Sites
Privacy Policy | Link Policy | Accessibility Policy | Security Policy | Michigan News | Michigan.gov Survey

Copyright © 2001-2012 State of Michigan