C.M.R. 02, 031, ch. 490, att. 031-490-B
Emotional impact of test
____ Emotional/coping assessment
____ Support system assessment
____ Suicide assessment
____ Follow-up appointment if necessary
Meaning of test
____ Anonymity/Confidentiality and restrictions on release of test results
____ Nature and reliability
____ Difference between HIV and AIDS; HIV disease progression
Medical follow-up
____ Prompt medical evaluation
____ Importance of early treatment
____ Immune system protection
____ Co-factors
____ STD / HEP / TB screening
____ Pregnancy options
Risk reduction
____ Importance of risk reduction for health maintenance and protection of partners
____ Risk/harm reduction plan formulated
Partner Counseling and Referral Services
____ Importance of informing sex/needle-sharing partner(s)
____ Assistance offered (coaching, role-play, or actually talking with partners)
____ Offer and explain Maine CDC Anonymous Partner Notification
____ Request assistance from Maine CDC
____ Client will: ____ use Maine CDC PCRS
____ History of blood/ semen/body fluid/organ donation discussed
COUNSELOR SIGNATURE / DATE:
C.M.R. 02, 031, ch. 490, att. 031-490-B