STD Case Management Templates and ICCR

Comprehensive Interview Record (CIR) (updated 2013)

  1. Comprehensive Interview Record (CIR) Templatepdf icon – blank copy
  2. CIR Codespdf icon
  3. CIR Instructionspdf icon
  4. Contact Continuation Template (CCT)pdf icon – supplemental page for additional contacts, social contacts, and associates
  5. CIR Tutorialppt icon Accessible pdfpdf icon
  6. All CIR Files ZIP – download all CIR files in a zipped file

Comprehensive Field Record (CFR) (updated 2013)

  1. Comprehensive Field Record Template (CFR)pdf icon – blank copy
  2. CFR Codespdf icon
  3. CFR Instructionspdf icon
  4. CFR Tutorialppt icon Accessible pdfpdf icon
  5. All CFR Files ZIP – download all CFR files in a zipped file

Cluster Interview Template (CIT) (updated 2013)

  1. Cluster Interview Template (CIT)pdf icon – blank copy
  2. CIT Instructionspdf icon
  3. Pursue and Cover: Cluster Interview Questionspdf icon
  4. CIT Tutorialppt icon Accessible pdfpdf icon
  5. All CIT Files ZIP – download all CIT files in a zipped file

Interview Record for Gonorrhea/Chlamydia (GC_CT)

  1. GC_CT Interview Recordpdf icon – Blank copy
  2. GC_CT Instructionspdf icon – Bubbled, long texted copy

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

  1. Congenital Syphilis Case Investigation and Reporting Formpdf icon
    To order Congenital Syphilis Forms, please contact Darlene Davis at 404-639-1838
  2. Congenital Syphilis Case Investigation and Reporting Form Instructionspdf icon (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.

 

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