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STD Case Management Templates and ICCR

Comprehensive Interview Record (CIR)  (updated 2013)

  1. Comprehensive Interview Record (CIR) Template  - blank copy
  2. CIR Codes
  3. CIR Instructions
  4. Contact Continuation Template (CCT)  - supplemental page for additional contacts, social contacts, and associates
  5. CIR Tutorial    Accessible pdf
  6. All CIR Files - download all CIR files in a zipped file

Comprehensive Field Record (CFR)  (updated 2013)

  1. Comprehensive Field Record Template (CFR) - blank copy 
  2. CFR Codes
  3. CFR Instructions
  4. CFR Tutorial    Accessible pdf
  5. All CFR Files- download all CFR files in a zipped file

Cluster Interview Template (CIT)  (updated 2013)

  1. Cluster Interview Template (CIT) - blank copy 
  2. CIT Instructions
  3. Pursue and Cover: Cluster Interview Questions
  4. CIT Tutorial    Accessible pdf
  5. All CIT Files - download all CIT files in a zipped file

Interview Record for Gonorrhea/Chlamydia (GC_CT)

  1. GC_CT Interview Record - Blank copy
  2. GC_CT Instructions - Bubbled, long texted copy

Congenital Syphilis Case Investigation and Reporting (Revised 2/2013)

  1. Congenital Syphilis Case Investigation and Reporting Form
    To order Congenital Syphilis Forms, please contact Darlene Davis at 404-639-1838
  2. Congenital Syphilis Case Investigation and Reporting Form Instructions (updated May 9, 2013)
  3. The Revised Congenital Syphilis Report Form - What's New, Why, and How to Use It - View webinar recorded April 29, 2013 by John R. Su, MD, Phd, MPH (May 2, 2013)

View Older Forms

 

Interstate Communications Control Records (ICCR) 

The DSTDP Field Services Branch (FSB) is now responsible for maintaining and updating the ICCR roster of state contacts used to confidentially share interstate public health information. This is a public health responsibility and Robin Senior of the FSB will be responsible for coordinating ICCR activities at the national level. She will maintain the ICCR roster. Ms. Senior will follow-up annually with STD directors to verify that their ICCR information is accurate. In the interim, please notify Ms. Senior of any changes to your ICCR information or any problems with the ICCR webpage by contacting her at 404.639.8183 or fzu1@cdc.gov.

 

 
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