STD Case Management Templates and ICCR

Comprehensive Interview Record (CIR) (updated 2013)

  1. Comprehensive Interview Record (CIR) TemplateCdc-pdf – blank copy
  2. CIR CodesCdc-pdf
  3. CIR InstructionsCdc-pdf
  4. Contact Continuation Template (CCT)Cdc-pdf – supplemental page for additional contacts, social contacts, and associates
  5. CIR TutorialCdc-ppt Accessible pdfCdc-pdf
  6. All CIR FilesCdc-zip – download all CIR files in a zipped file

Comprehensive Field Record (CFR) (updated 2013)

  1. Comprehensive Field Record Template (CFR)Cdc-pdf – blank copy
  2. CFR CodesCdc-pdf
  3. CFR InstructionsCdc-pdf
  4. CFR TutorialCdc-ppt Accessible pdfCdc-pdf
  5. All CFR FilesCdc-zip– download all CFR files in a zipped file

Cluster Interview Template (CIT) (updated 2013)

  1. Cluster Interview Template (CIT)Cdc-pdf – blank copy
  2. CIT InstructionsCdc-pdf
  3. Pursue and Cover: Cluster Interview QuestionsCdc-pdf
  4. CIT TutorialCdc-ppt Accessible pdfCdc-pdf
  5. All CIT FilesCdc-zip – download all CIT files in a zipped file

Interview Record for Gonorrhea/Chlamydia (GC_CT)

  1. GC_CT Interview RecordCdc-pdf – Blank copy
  2. GC_CT InstructionsCdc-pdf – Bubbled, long texted copy

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

  1. Congenital Syphilis Case Investigation and Reporting FormCdc-pdf
    To order Congenital Syphilis Forms, please contact Darlene Davis at 404-639-1838
  2. Congenital Syphilis Case Investigation and Reporting Form InstructionsCdc-pdf (updated July 10, 2014)
  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)

Interstate Communications Control Records (ICCR)

The Interstate Communications Control Records (ICCR) roster of state/project area contacts is used to confidentially share interstate/inter-project area (domestic) public health information. The Division of STD Prevention’s Program Development and Quality Improvement Branch (PDQIB) will maintain this ICCR roster for the purpose of sharing STD prevention information (HIV-related contacts will be included as well). Updates will occur periodically.

Please note we are unable to accept international referrals at this time.

Any changes in points of contact should be sent to Steven Shapiro at


Download Instructions

View Older Forms