Transmittal of Clinic Variables

Form Approved OMB No. 0920-New Expiration Date: XX/XX/XXXX Cooperative Re-Engagement Controlled Trial (CoRECT) Attachment #4 Electronic CoRECT clinic data variables Public reporting burden of this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New) Attachment 4: Electronic CoRECT clinic data variables
Data Elements	Variables Collected from CoRECT Clinic
	Collected at enrollment:
1	Unique patient study ID
2	CoRECT clinic assigned
3	Date of first visit to this HIV clinic
4	Ever received ARVs at this clinic prior to enrollment
5	Ever achieved viral suppression at this clinic prior to enrollment
	Collected at each visit:
6	Date of scheduled HIV primary care visit
7	Date the HIV primary care appointment was created
8	Type of visit (e.g., laboratory, prescribing provider, case management, social work, etc.)
9	Disposition of the scheduled HIV primary care visit (kept, cancelled, no-show)
10	Primary insurance
11	Prescribed antiretroviral medications (yes/no)