AIDS and HIV infection are reportable to local health authorities in Washington under WAC 246-101, within 3 working days and without patient consent. DOH 150-002 is the state's adult case report, the Washington version of the CDC adult form. It collects identifiers, diagnosis facility and provider, HIV diagnostic and care tests, patient history, opportunistic illnesses and treatment history.
The health care provider who diagnoses or treats HIV completes pages 1 and 2, leaving the 'For State Health Department Use Only' and local fields blank. Page 3 holds footnotes and code lists.
Download the current version from the source each time; forms change without notice.
WA Confidential HIV/AIDS Adult Case Report
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No. Page 3 of the form states that HIV/AIDS cases are reportable within 3 working days under WAC 246-101 and that reporting does not require patient consent. Case reports are kept as confidential records, and several state laws protect patient identifying information.
The history section asks whether the patient has ever taken antiretrovirals and lists HIV treatment, PrEP, PEP, PCP prophylaxis and other ARVs with start dates, current use and last use. It also asks about methamphetamine use, referrals to HIV medical and case management services, and current pregnancy.