Louisiana Department of Health & Hospitals | Bruce Greenstein, Secretary

Prevetion Forms

Miscellaneous Documents

• Final Testing Laws Memo
• Forms and Internventions Overview 2008
• HERR Services Program Info Worksheet
• Referral Form Front
• Referral Form Back

HIV/AIDS Program Enrollment Guide and Form

• Guide: HAP Enrollment Form
• PEMS: HAP Enrolllment Form

MPowerment

• Guide: MPowerment MGroup Session Log
• MPowerment MGroup Session Log
• Guide: MPowerment Core Session Log
• MPowerment Core Session Log
• Guide: MPowerment Outreach Log
• MPowerment Outreach Log
• Guide: MPowerment Quarterly Checklist
• MPowerment Quarterly Checklist

Outreach Guides and Forms

• Outreach Documentation
• Guide: Outreach Site Activity Log
• PEMS: Outreach Site Activity Log
• PEMS: Collaborative Outreach Site Activity Log
• Guide: Outreach Site Registration
• Outreach Site Registration Form
• Guide: Quarterly Outreach Summary Report 08
• PEMS: Quarterly Outreach Summary Report

CBO Forms

• CBO Manual
• Test Code Results
• CBO Partner Form
• CBO Original Form
• CBO Original Patient Form
• CBO Partner Elicitation Form

Risk Management Forms

• Risk Management Documentation Protocol
• PEMS: Risk Management Activity Log
• RM Screening Tool

SGS and PWP Protocols and Forms

• SGS & SGS-PWP Documentation Protocol
• SGS Quarterly Reporting Checklist
• PEMS: Small Group Session Log
• PWP Program Assessment Updated 03/01/11

CTRS Protocols and Forms

• Louisiana CTRS Protocol Page 1
• Louisiana CTRS Protocol Page 2
• 2010-2011 Memo and RRP Worksheet 11/10

Latino Project Flyers

• Latino Project Testing Flyer English
• Latino Project Testing Flyer Spanish

Educational Material Order Forms

• Educational Materials Order Form 2012A