Pediatric HIV AIDS Case Report Form

Form Template

The Pediatric HIV/AIDS Case Report Form app is a critical tool for HIV/AIDS surveillance and public health protection.

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With this app, a health investigator will gather relevant information about a pediatric patient living with HIV. The health investigator will provide patient identifier information and healthcare provider information, and facility of diagnosis, followed by the diagnosis status such as pediatric HIV/AIDs or Perinatal HIV. The health investigator can record patient history and documented laboratory tests. The app user can check and date any disease indicators including bacterial infection, pneumonia or lung infection. With the app, the health investigator will thoroughly document birth history, prenatal care, anti-retroviral drug history, and describe any medical treatment for the HIV infection. This app can be completed and submitted to the Department of Health and Human Services Communicable Disease Surveillance Section. This documentation is critical for providing care for children living with HIV and to prevent further HIV transmission.

Features
  • Signature Capture
  • GPS
  • Image Capture
  • Conditional Fields
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Platforms
  • iPhone
  • iPad
  • Android
  • Windows
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Integrations
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
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*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

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“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

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