Introduction to the Electronic Adult HIV/AIDS Case Report Form Georgia Department of Public Health HIV/AIDS Surveillance Program

Introduction The Georgia Department of Public Health has developed the Electronic Adult Case Report Form (eACRF). This form is supported by State Electronic Notifiable Disease Surveillance System (SendSS). This form does not replaces the current avenues that are available for reporting HIV/AIDS. This presentation will provide generalized steps for accessing and submitting the eACRF.

HIV Reporting Differs From Notifiable Disease Reporting Reporting HIV/AIDS in SENDSS is a different process and has features to protect PII. It is only meant to replace having to mail forms to HIV Surveillance. Please Note… You cannot search patients in the HIV Case Reporting Module as you can in other disease reporting modules. You cannot retrieve case reports that you have previously submitted.  A 15 minute time out clock starts after entering your first data point on the form. If you don’t finalize your form before the clock times out your data will be lost and nothing submitted. Please print out your HIV case reports to retain a record of what you have reported.

Register or Login to SendSS To access the eACRF the reporter will have to login to SendSS . If you do not have a login, you will have to register. SendSS can be accessed at: https://sendss.state.ga.us/sendss/login.screen Registration Form for New Account Login How to Use SendSS Training How to Register on SendSS Training

Agree with Disclaimer To move Forward

Navigate to the eACRF Case Reporting Tab HIV/AIDS Case Report

Please notice there are a few required items you must have to submit a complete report. Without these the form will not save and submit. Once you verify you have those items, please click “Yes” here.

Please do your best to complete every section of the form. The only variables that are required to successfully submit the eACRF are the variables with the RED dot beside them.

Facility Lookup Facility Completing the Form, Facility at HIV Diagnosis, Facility at AIDS Diagnosis Click this link This popup will take you to the look up table

Facility Lookup Continued. Type in a facility key word Select the facility with the right address

Facility Lookup Continued. Click here if same as facility completing the form Hand enter if not on facility table

Residence at HIV and/or AIDS Diagnosis Physician Residence at HIV and/or AIDS Diagnosis

Patient Risk History

HIV Test Results Select this only option also for GEENIUS test. (Any Type Differentiating AB test) Please check all drop down menus for test names. They are organized by: Antibody -Type Differentiating and Non-Type Differentiating Antigen – Qualitative and Quantitative Immunologic Test – CD4 only. No CD3 or CD8 needed

HIV Test Results continued

STD Co-Infections

AIDS Defining Opportunistic Infections

Medical Treatment and Pregnancy Hx

HIV Testing and ART Hx

Comments & Save Please enter any extra tests or important additional information in the Comments box. Once all the information is entered in the form click the “Save” button

Error Check Box If any mistakes are made this box will be appear.

Review Form You will be given the chance to review the form. If you see any mistakes, click “Edit” to return to the document. If all is correct, click “Print Version” to print a version of your form or click “Finalize”.

Once you click “Finalize”, the system will tell you that this is your last opportunity to review the form before it is submitted Press “Edit” if you see a mistake. Print a copy for your records. Click “Finalize” now to complete submission .

Enter Another Form or Exit Once you completed the eACRF and successfully submitted it, this box will appear Click “Continue” to enter another eACRF. Click “Exit” to exit the HIV Reporting Module.

Georgia HIV Surveillance Section QUESTIONS? Georgia HIV Surveillance Section 1-800-827-9769 No Faxing Permitted Georgia Department of Public Health, Epi Section P.O. Box 2107 Main Web Page: http://dph.georgia.gov/georgias-hivaids-epidemiology-surveillance-section Please check in periodically for annually updated paper ACRF forms, Research, HIV Fact Sheets and Surveillance Summaries https://dph.georgia.gov/reporting-forms-data-requests https://dph.georgia.gov/data-fact-sheet-summaries