Generic versions of clinic forms developed by i-Base and the Royal Free Centre for HIV Medicine. Some forms have space for patient stickers and for a hospital or clinic logo from your own clinic or health Trust. If you have any difficulty with these forms, or would like help adapting them for your Trust, please contact i-Base.
1 September 2014. Related: Clinic forms, Publications.
New patient first visit PDF Six-page document for recording more detailed notes when seeing a patient for the first visit. The 2014 update is especially important for including a wider category of gender options in order to ensure transgender patients …
27 June 2008. Related: Clinic forms, HIV positive people, Publications, Resources.
Adherence support chart and side effects diary PDF Double-sided sheet for patients to record when they have taken their medication and on the reveres side a side effects diary, Adherence support chart PDF Single-sided sheet for patients to record when …
26 June 2008. Related: Clinic forms, General, Publications, Resources.
CD4 and viral load chart PDF Single-sided sheet for patients to graph their CD4 and viral load results, and to explain when to start treatment. This is a generic version of a clinic form developed by i-Base and the Royal …
25 June 2008. Related: Clinic forms, Publications.
Cardiovascular risk PDF Single-sided sheet for recording a patients cardiovascular risk factors.
21 June 2008. Related: Clinic forms, Publications.
Hepatitis record sheet PDF Single-sided sheet for recording hepatitis A/B/C status annually.
21 June 2008. Related: Clinic forms, Publications.
Day case PDF Single-sided sheet for recording patient notes when seen as a day case.
21 June 2008. Related: Clinic forms, Publications.
Patient update PDF Single-sided annual summary including lab results.
21 June 2008. Related: Clinic forms, Publications.
Summary patient notes PDF Single-sided sheet summarising changes in ARV treatment. Revised Apr 08
21 June 2008. Related: Clinic forms, Publications.
Ethnic monitoring PDF 2-sided sheet for collecting voluntary information about patient ethnicity.