Table 1: Items Reportable on a Diagnosed HIV Case Report Form

Demographic Information
● Name
● Date of birth
● Ethnic group
● Marital status
● Education level
Disease Information
● HIV positivity
● Clinical diagnosis of AIDS†
Clinical HIV Diagnosis Test
● Source of the blood sample*
● Status of the confirmation test
● Confirmation test date and location
History of High-Risk Behaviors, (Ever Involved in or Had)
● Intravenous drug usage
● Extramarital sexual activities
● HIV-positive regular sexual partner
● Sexual acts with MSM
● Blood donation
● Receiving blood transfer
● Positive maternal HIV status
● Occupational exposure to HIV
● Major surgery
Likely Route of Transmission
● Sharing of injection equipment
● Heterosexual transmission
● Homosexual transmission
● Blood contacts (donation/reception)
● Mother-to-child transmission
● Occupational exposure
Reporting Organization
● Name of the organisation
● Name of the reporting clinician
● Contact details and report date

† Without specifying disease stages.
* Circumstances which the blood sample was drawn, including pre-surgery testing, premarital testing, voluntary blood donation, paid blood donation, tests for children with positive maternal status, detention center personnel testing, pregnancy blood testing, occupational exposure testing, sexual health clinic testing, voluntary counseling and testing, new army recruits testing, migration body check, testing for discordant couples, scientific surveys, testing for entertainment personnel and others.