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HIV Testing Consent Form
Consent

HIV Testing Consent Form

2 pages•12 fields•HIPAA-ready
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HIV Testing Consent Form
Patient Full Name
Date of Birth
Test Type
Select...
Pre-Test Information Reviewed
Confidentiality Protections Acknowledged
Counseling Services Offered
Preferred Results Notification Method
Select...
Right to Decline Testing Acknowledged
Consent to HIV Testing
I agree to the terms above
Sign here
Patient Signature
Sign here
Date of Consent
Submit
Use this template

The HIV Testing Consent Form is designed to meet the specific legal and ethical requirements surrounding HIV testing in healthcare settings. While many states have moved toward opt-out testing models, most still require some form of documented consent, and this form ensures compliance with varying state regulations while respecting patient autonomy and privacy.

This template includes pre-test information about the types of HIV tests available (rapid, antibody, antigen/antibody combination, and nucleic acid tests), what the results mean including the window period for detection, and the confidentiality protections afforded to HIV test results under state and federal law. It also documents that the patient has been informed about available counseling services and support resources regardless of their test outcome.

Appropriate for primary care practices, community health centers, sexual health clinics, emergency departments, and public health testing sites, this form helps healthcare providers navigate the sensitive nature of HIV testing while maintaining full compliance with state-specific consent requirements and federal confidentiality protections.

What's included

  • Patient identification and demographics
  • HIV test type selection and information
  • Pre-test counseling acknowledgment
  • Confidentiality and privacy protections disclosure
  • Results notification preference
  • Patient signature and right to decline
  • Consent agreement with e-signature

Who uses this template

  • Documenting informed consent before HIV screening in clinical settings
  • Meeting state-specific consent requirements for HIV testing
  • Recording pre-test counseling and confidentiality acknowledgment
  • Providing patients with information about test types and result notification

All form fields

11 fields across 2 pages. Customize any field after signing up.

Patient Full NameText
Date of BirthDate
Test TypeDropdown
Pre-Test Information ReviewedCheckbox
Confidentiality Protections AcknowledgedCheckbox
Counseling Services OfferedMultiple Choice
Preferred Results Notification MethodDropdown
Right to Decline Testing AcknowledgedCheckbox
Consent to HIV TestingConsent Agreement
Patient SignatureE-Signature
Date of ConsentDate

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