1. HIV Screening Clinical Reminder Hampton VAMC 1

2. Clinical Reminder Key Features - 1 Applies to all veterans without prior HIV diagnosis or life expectancy <6 months Satisfied by previous HIV testing performed at the facility or documented as performed at an outside facility If a patient refuses, turned off for one year.* Allows provider to document outside testing done (month/year and result if known) *period can be changed at local option 2

3. CR Key Features -2 If outside positive test recorded, can consult to ID clinic or document that patient declined HIV test quick order; inserts progress note text documenting patient verbal consent Link to patient handout to satisfy the written information requirement Uses same term as Annual HIV Test Reporting extract for internal consistency and to avoid unnecessary duplication 3

4. Initial Dialog 4

5. Quick Order for HIV Test Link to patient handout PN text documents verbal consent 5

6. Documentation of outside testing 6

7. Outside Test - Positive Option to refer to ID Clinic, document patient refusal Month/ year required 7

8. Outside Test - Negative Month/ year required 8

9. Outside Test – Result Unknown Month/ year required 9

10. Patient Declines Documents decline, turns off reminder for one year Provider can still access printed handout if desired 10

11. Life Expectancy < 6 Months Records HF, turns off CR 11

12. ORA-QUICK TEST RN WILL DO POINT OF CARE (POC) TESTING WHEN VETERAN PRESENTS, AFTER VERBAL CONSENT. TAKES ABOUT 20 MINUTES DOCUMENTS RESULT IN CPRS IF POSITIVE, WILL CONFER WITH PROVIDER, WHO WILL THEN ORDER ANTIBODY TEST. RN TO BE VALIDATED BY Ms. Terri Batten, Pathology. 12

13. What happens after screening Lab will do serum a/b test. If positive, will automatically do confirmatory Western blot test If positive, lab will directly inform provider as “critical value”. Provider responsibility – counsel patient and refer to ID clinic for further followup. ID NP/ Dr. Stott get +ve as well, and follow. 13

14. Reminder burden on Providers Screening reminder – LPN/Health Tech PACT – None to provider Oral test if +ve – Provider to order serum a/b test < 1 minute Confirmatory test if +ve - Provider to counsel patient and refer to ID clinic (may use telephone appointment time). 14