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Initial History and Physical Assessment Form for HIV Patients


This comprehensive form can be used by health care providers to collect information at the initial interview session for all new patients in an HIV program.

The form includes the following sections:
  • Demographics
  • HIV exposure risks
  • History of present illness
  • Past medical history
  • Physical exam
  • Assessment
  • Discharge planning
Free registration is required.


Christiana Care Health Services

Funding Sources

Christiana Care Health Services

QualityTool Topic



  • Release Date: 03/2003
  • Original Summary: 12/2008
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
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Last updated: March 12, 2014.