HIV CASE REPORTING

Adult HIV Confidential Case Reporting Form (2 MB PDF)
(Patients ≥ 13 years of age at time of diagnosis)

Pediatric HIV Confidential Case Reporting Form (2 MB PDF)
(Patients < 13 years of age at time of diagnosis)

Please send completed reports in a double envelope marked “Confidential”

Mail completed form to:
Florida Department of Health in Duval County
HIV/AIDS Surveillance Office
900 University Blvd. N.
Mail Code: 39
Jacksonville, FL32211

All health care providers diagnosing and/or providing care to a patient with HIV are obligated to report using Florida HIV/AIDS Case Report. Case reports should be completed within fourteen (14) days after diagnosing or providing care to a patient with HIV/AIDS.