2 Event Record

OMB No.: 0915-0281
Expires:

HRSA AIDS Education and Training Centers
EVENT RECORD

ER
1. Date of Event (mm/dd/yy)

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dd
yy
2. Topics (Fill in the circle(●) to the left of ALL topics covered in
the program.)
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Clinical Management/Treatment
Adherence
Antiretroviral Treatment
Non-ART Treatment
Basic Science/Epidemiology
Clinical Manifestations of HIV Disease
Co-Morbidities
HIV Routine Laboratory Tests
Hepatitis A, B, C
Nutrition
Opportunistic Infections
Oral Health
Post-Exposure Prophylaxis, (Occupational & Non-Occup)
Resistance
Routine Primary Care Screenings
Health Care Organization and Delivery Issues
Agency Needs Assessment
Community Linkages
Cultural Competence
Education Development/Delivery
Grant Issues
Health Literacy
Health Care Development/Clinical Service Coordination
Health Care Organization and Finances
HIPAA/Confidentiality
Quality Improvement
Resource Allocation
Technology
Prevention and Behavior Change
HIV Risk Assessment/Screening
Risk Reduction
Routine HIV Testing
Psychosocial Issues
Mental Health
Substance Abuse
Targeted Populations
Adolescent (Ages 13 – 24)
Children (Birth – 12)
Gay/Lesbian/Bisexual/Transgender
Homeless/Unstably Housed
Immigrant/Border Populations
Incarcerated Individuals
People Over 50 Years of Age
Racial/Ethnic Minorities
Rural Populations
Women
Other Population (specify) __________________________

3. Indicate if funds from any of the following initiatives were
used to support this event. (Select all that apply)
O American Indian/Alaska Native
O Border Health Initiative
O Minority AIDS Initiative (MAI)
O None of the above

Office
Use
Only

February
2007

AETC

Sub-site

4. Select all organizations that helped with this
event. (Select all that apply)
O None
Other Training Centers
Other AETCs
O Addiction Technology Transfer Center (ATTC)
O Delta
O FL/Caribbean
O Midwest
O Mtn. Plains
O New England
O NY/NJ
O Northwest
O Pacific
O PA/Mid-Atlantic
O Southeast
O TX/OK
O Ntl. Clinicians’
Consult. Ctr. (NCCC)
O Ntl. Minority AETC
O Ntl. Resource Ctr.
O Ntl. Evaluation Ctr.

O Area Health Ed. Center (AHEC)
O Prevention Training Center (PTC)
O Regional Training Center (RTC)
O TB Training Center

Other Agencies

O AIDS Community-Based Organization
O College/University/Health Professions
School
O Faith-Based Organization
O Community Health Center
O Historically Black College or
University/Hispanic Serving Institution/Tribal
College or University
O Hospital/Hospital-Based Clinic
O Ryan White CARE Act Funded Programs

5. # of Participants
6. # PIFs collected
7. Length of Session
Total Hours of Event: Fill in hours of event to the nearest quarter hour:
.25=1/4 hour, .50=1/2 hour, .75=3/4 hour
Level I

Didactic
Presentation

.

Level II

Skills
Building

.

Level III

Clinical
Training

.

Level IV

Group Clinical
Consultation

.

Level IV

Individual
Clinical
Consultation

.

Level V

Technical
Assistance

.

8. Select the following training modalities or technologies that
were applied in this event. (Select all that apply)
O Chart/Case Review
O Clinical Preceptorship/Mini-Residency
O Computer-based
O Conference Call/Telephone

Program ID

O Lecture/Workshop
O Role Play/Simulation
O Self-study
O Telemedicine