CDC 50.42B is the pediatric counterpart to the adult HIV case report, used for children under 13 at diagnosis or at perinatal exposure. A pediatrician or birth facility meets it when an infant is born to a mother with HIV, or a child is diagnosed with HIV or AIDS. The status at report can be perinatal exposure, pediatric HIV, pediatric AIDS or pediatric seroreverter, so it also documents exposed infants who prove uninfected.
The provider or facility caring for the child completes section I and sections III through XIII, including clinical and laboratory data, birth history and the biological mother's history. Section II is completed only by health department staff.
Download the current version from the source each time; forms change without notice.
Pediatric HIV Confidential Case Report Form
If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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Children who were under 13 at the time of perinatal HIV exposure or HIV diagnosis. The form covers four statuses: perinatal HIV exposure, pediatric HIV, pediatric AIDS and pediatric seroreverter. Patients 13 or older at diagnosis are reported on the adult form, CDC 50.42A.
From your state or local health department, which distributes it; CDC does not post it publicly. Georgia DPH posts the revision 04/2026 as a six-page print copy, some health departments post fillable versions, and several states use their own versions, such as Texas DSHS 13-13675.