Forms for EIMS outage
| Published Year | Title | PDF Format |
| 2025 | Patient Registration Form | [ PDF - 74 KB ] |
| 2025 | STI Clinic Form | [ PDF - 74 KB ] |
| 2025 | Prescription to pharmacy/injection room | [ PDF - 87 KB ] |
| 2025 | Medical record for PEP/PEPSE |
[ PDF - 128 KB ] |
| 2025 | Medical record for PrEP | [ PDF - 109 KB ] |
Minimal paper documentation in HIV clinics in addition to EIMS
| Published Year | Title | PDF Format |
| 2025 | ART Medical record 1st visit | [ PDF - 294 KB ] |
| 2025 | ART Medical record follow up visits | [ PDF - 507 KB ] |
STD Reporting formats
| Published Year | Title | PDF Format | Editable Format |
| 2024 | Quarterly STD Return-version 31.01.2024 | [ PDF - 1049 KB ] | |
| 2023 | Quarterly STD Return-version 15.05.2023 | [ PDF - 444 KB ] | |
| 2022 | Quarterly STD Return – version 25.04.2022 | [ PDF - 497 KB ] | |
| 2017 | Quarterly STD Return – version 29.05.2017 (not in use after Q4-2021) | [ PDF - 453 KB ] | [ DOC - 236 KB ] |
| 2017 | HIV Confirmatory Request & Strategic Information Form 7.4.2017 | [ PDF - 172 KB ] | |
| 2016 | Data on Pregnancy & Sexually Transmitted Infections | [ PDF - 270 KB ] | [ DOC - 42 KB ] |
| 2016 | Report of the outreach blood screening programme for Prisoners | [ PDF - 178 KB ] | [ DOC - 36 KB ] |
| 2011 | HIV & STI Among MARPS Escorted to the STD Clinic | [ PDF - 267 KB ] | [ DOC - 33 KB ] |
| 2011 | Quarterly return - STI Laboratory - Version 12.12.011 | [ PDF - 18 KB ] | [ DOC - 42 KB ] |
STD Recording formats
| Published Year | Title | PDF Format | Editable Format |
| 2016 | Main Register Format 2016.12.07 | [ PDF - 420 KB ] | [ XLS - 40 KB ] |
| 2016 | Subsequent Visit Register Format | [ PDF - 321 KB ] | |
| 2016 | Microscopist daily Register 2016.08.02 | [ PDF - 195 KB ] | |
| 2016 | Routine OPD Blood Examination Register | [ PDF - 189 KB ] | [ XLS - 33 KB ] |
| 2016 | IEC/Awareness Programme Register | [ PDF - 191 KB ] | |
| 2011 | Form for Strategic Info on Lab confirmed HIV infections 06.07.2011 | [ PDF - 152 KB ] | [ DOC - 83 KB ] |
| 2010 | Male clinic form (PIMS) - Version 14102010 | [ PDF - 283 KB ] | [ DOC - 188 KB ] |
| 2010 | Female clinic form (PIMS) - Version 14102010 | [ PDF - 270 KB ] | [ DOC - 203 KB ] |
ART Reporting formats
| Published Year | Title | PDF Format | Editable Format |
| 2017 | Quarterly return from HIV care/ART center –version 29.05.2017 | [ PDF - 276 KB ] | [DOC-154KB] |
ART Recording formats
| Published Year | Title | PDF Format | Editable Format |
| 2017 | ART Card-2017.03.31 | [ PDF - 785 KB ] | |
| 2016 | Antiretroviral Drug Dispensing Register-2016.08.03 | [ PDF - 219 KB ] | |
| 2016 | Pre-ART Register | [ PDF - 168 KB ] | [ DOC - 146 KB ] |
| 2016 | ART Register | [ PDF - 253 KB ] | [ XLS - 36 KB ] |
EMTCT Formats and Tools
| Title | PDF Format |
| EMTCT HIV Case Investigation form | [PDF - 587 KB ] |
| EMTCT Syphilis case investigation form | [PDF - 585 KB ] |
| EMTCT HIV-STD Clinic Supervision Checklist EMTCT HV 11.2018 | [PDF - 293 KB ] |
| EMTCT Syphilis-STD Clinic Supervision Checklist EMTCT HV 11.2018 | [PDF - 255 KB ] |
| STD Clinic supervision report | [PDF - 226 KB ] |
| Data-assessment tool Global amended 29 March 2018 | [PDF - 1.34 MB] |
| HR GE CE assessment tool | [PDF - 177 KB ] |
| Laboratory assessment | [PDF - 1.6 MB ] |
| Program assessment tool EMTCT 2018 | [PDF - 926 KB ] |
| Postnatal survey format | [PDF - 521 KB ] |
KP monitoring formats
| Title | PDF Format | Editable Format |
| HIVST Stock Management Register by STD clinic | [PDF - 116KB] | [DOC - 27KB] |
| Unique Identifier Code (UIC) - Sinhala | [PDF - 950KB] | |
| Unique Identifier Code (UIC) - Tamil | [PDF - 328KB] | |
| Client Registration Form (Version 10.1.2020) - Sinhala | [PDF - 247KB] | |
| Clinic Escort, Referral for H - Sinhala | [PDF - 255KB] |
|
| PE Daily record form (Peer-led mod) - Sinhala | [PDF - 175KB] |
|
| Generating the new UIC 10.3.2020 - Sinhala | [PDF - 295KB] |
|
| Client Registration Form - Tamil | [PDF - 244KB] | [DOC - 60KB] |
| Refreal Form - Tamil | [PDF - 201KB] | [DOC -66KB] |
| PE Daily Record Form - Tamil | [PDF - 177KB] | [DOC -49KB] |
| Outreach Rapid HIV Test Result Form | [PDF - 121KB] | [DOC - 62KB] |
| Condom Stock Management Form (Version 10.1.2020) | [PDF -255KB] | [DOC - 75KB] |
| KP Prevention Reporting Format (Version 10.1.2020) | [PDF - 145KB] | [DOC - 46KB] |
| Data Collection and Reporting Guidelines (For KP Prevention Programme implemented by NSACP) | [PDF -222KB] | [DOC - 90KB] |
| Summary - Primary Forms for KP Prevention programme | [PDF - 107KB] | [DOC - 34KB] |
Quarterly return from HIV care/ART centre –version 29.05.2017
