Rapid HIV Test Informed Consent Form - DOC by 6QNZXan1

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									Form #252 Org: 11/08
                                         Satilla Community Services
                                                Rapid HIV Test
                                           Invalid Test Case Report
                                               CLIA # 11D1087587


This form is to be completed for ALL testing situations that involve an invalid rapid test result.

Site Name: _______________________________________________Date:_______________________

Person Completing Report: _______________________________                  Test Kit Lot#:_______________

Client Code: _______________________________________ Age:________

Client Gender




Reason rapid test was invalid (check all that apply):

                                                           ult to read result after 20 minutes (OraQuick)



                                                                                 ____________

Was a rapid test repeated on this client?

If no, what was the reason a repeat test was not performed?




                              o obtain an additional specimen



If yes, what was the result                             -reactive

Were external controls run immediately following the invalid rapid test?



If yes, what were the results of the control tests run?
                       -
       -
                            -reactive control passed

								
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