STD Case Management Templates and ICCR
Comprehensive Interview Record (CIR) (updated 2013)
- Comprehensive Interview Record (CIR) Template – blank copy
- CIR Codes
- CIR Instructions
- Contact Continuation Template (CCT) – supplemental page for additional contacts, social contacts, and associates
- CIR Tutorial Accessible pdf
- All CIR Files – download all CIR files in a zipped file
Comprehensive Field Record (CFR) (updated 2013)
- Comprehensive Field Record Template (CFR) – blank copy
- CFR Codes
- CFR Instructions
- CFR Tutorial Accessible pdf
- All CFR Files– download all CFR files in a zipped file
Cluster Interview Template (CIT) (updated 2013)
- Cluster Interview Template (CIT) – blank copy
- CIT Instructions
- Pursue and Cover: Cluster Interview Questions
- CIT Tutorial Accessible pdf
- All CIT Files – download all CIT files in a zipped file
Interview Record for Gonorrhea/Chlamydia (GC_CT)
- GC_CT Interview Record – Blank copy
- GC_CT Instructions – Bubbled, long texted copy
Congenital Syphilis Case Investigation and Reporting (Revised 2/2013)
- Congenital Syphilis Case Investigation and Reporting Form
To order Congenital Syphilis Forms, please contact Darlene Davis at 404-639-1838 - Congenital Syphilis Case Investigation and Reporting Form Instructions (updated July 10, 2014)
- 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.