HIV Prevention Portal: Forms

Form instructions and due dates:

1. Click on the form's link.
2. “Save” or “Save As” to your computer.
3. Email completed forms to health.hivprevention@state.mn.us

• HIV Prevention Grant Manager Contact List (PDF)
  Use this list to locate contact information for your grant manager for all MDH-funded HIV prevention grants. All communications should be directed to your grant manager.

Invoice

• For a new invoice form template, please email request to health.hivprevention@state.mn.us.

HIV testing

• HIV/AIDS Confidential Case Report Forms
• STI, HIV, and Hepatitis Risk Assessment (Optional template)
• Client Consent to HIV and/or HCV Testing Template (PDF)
• OSHA Bloodborne Pathogen Exposure Plan (PDF)

Clinical Laboratory Improvement Amendments (CLIA)

• CMS: CLIA Certification Quick Start Guide (PDF)
• CMS: Clinical Laboratory Improvement Amendments (CLIA) Application for Certification (PDF)
• CMS: State Agency & CLIA Operations Branch Contacts
• CMS: CLIA Certificate Fee Schedule (PDF)

Materials review

• HIV-Related Educational Materials Review