STD Forms

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STD Forms

STD Interview Record (IR) and Instructions

IR form
This IR form replaces the old interview record, intelligence sheet, and comment sheet with a single document containing new data elements which will give programs the ability to monitor risk behaviors and better understand who is becoming infected and why.

New data elements in the IR form will also be included in the new STD Morbidity Report form. Beginning January 1, 2008 reporting these data will be required in the STD Morbidity Report.

Interview Record (March 7, 2008)
Interview Record Instructions (March 7, 2008)
Gonorrhea/Chlamydia Interview Record (June 5, 2008)
Gonorrhea/Chlamydia Interview Record Instructions (June 5, 2008)
IR FAQs
IR Training
Mock IR Practice Case
- Case Notes
- Case Write Up on Interview Record
Dear Colleague Letter - from John M. Douglas, Jr., MD., Director, Division of STD Prevention

Performance Measures

STD Performance Measures, 2005-2006 Data Report

Other Downloadable Forms and Instructions

Field Record (Buff Work Copy)
Re-Interview Record - CDC Form 73.54B.
Cluster Interview Record - CDC Form 73.54C
Sexually Transmitted Disease Morbidity Report - CDC Form 73.688.
Report of Civilian Cases of P&S Syphilis, Gonorrhea, and Chlamydia - CDC Form 73.2638

Note: Some hardcopy forms can be ordered online from the Field Intervention Forms and Reference Documents Web Page. Contact your supervisor for user id and password.

Page last modified: June 10, 2008
Page last reviewed: June 10, 2008
Content Source: Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention