Contact Tracking Log

Attachment 5d_Contact Tracking Log.docx

Exploring HIV Prevention Communication among Black Men Who Have Sex with Men in New York City: Project BROTHA

Contact Tracking Log

OMB: 0920-0872

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Exploring HIV Prevention Communication Among Black Men Who Have Sex with Men in New York City: Project BROTHA”


0920-XXXX



Attachment 5d. Contact Tracking Log

BMSM


BMSM: Participant Contact Tracking Log ID Number:____ ____ ____ ____



Please record all communication made with participant.


Date


Reason for contact


Outcome/notes


Staff Name

/ /


Screening


Scheduled



/ /







/ /







/ /







/ /







/ /







/ /







/ /







/ /









NOTES:












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File Created2021-02-02

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