CTRPN Follow-up to Preliminary Site Visit Questions Grid I (INTERVIEW)
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These questions are intended to be completed by all sites in order to verify accuracy of original information and obtain missing information from the PSV. They will be asked of staff during staff interviews..
Purpose : To provide us with information on clinic efficiency and staff workload.
Site________________________ Date____________________ Interviewer_______________________
| Epi/ CDS |
Nurse | Clerk | Health Services Tech | Prog.
Coord./ admin. |
Other adminis-trator | Health Educ. | MD | Other | |
| Who is trained to do counseling? | |||||||||
| Who MAINLY does counseling? | |||||||||
| Who is trained to do HIV testing (i.e. draw blood, take specimens)? | |||||||||
| Who MAINLY does HIV testing?? | |||||||||
| Who is trained to do STD testing (i.e. draw blood, take specimens)? | |||||||||
| Who MAINLY does STD testing? | |||||||||
| Who primarily gives HIV+ test results? | |||||||||
| Who primarily gives HIV- test results? | |||||||||
| Who primarily gives STD test results? | |||||||||
| Who is trained to conduct PN? |
CTRPN Follow-up to Preliminary Site Visit Questions Grid II: Interview
page 1 of 1
These questions are intended to be completed by all sites in order to verify accuracy of original information and obtain missing information from the PSV. They will be asked of staff during staff interviews. Answers may vary depending on the person responding (e.g. how long a counseling session is may depend on the counselor). Purpose: This grid will provide us with information on what diseases are given the most time and attention. These responses must be considered with respect to the site’s incidence/prevalence rates of disease.
Site________________________ Date____________________ Interviewer_______________________
| HIV / AIDS | Gonorrhea | Syphilis | Chlamydia | TB | Hepatitis | Other | |
| Does pre-test counseling occur for this disease? | |||||||
| Does post-test counseling occur for this disease? | |||||||
| Do you use any of the following methods to follow up on patients recently tested for this STD: Telephone | |||||||
| Home (field) visit | |||||||
| Letter | |||||||
| Other | |||||||
| Are patients with this STD generally referred elsewhere for treatment? | |||||||
| Is PN done for this disease? | |||||||
| If yes, is it mandatory, or generally done but not mandatory? | |||||||
| If client is notifying partner, how long does Epi wait before contacting partner if they don’t come in? | |||||||
| Is a "self-referral card" or "contact card" given to the original patient to give to partner for this disease? |
Feedback to Melanie Bliss