Document

EvaluationWeb screen shots

ICR 202605-0920-005 · OMB 0920-0696 · Object 169437000.

Document Viewer [docx]

Status: Original and derived artifacts are available for this document.

Download: docx | pdf | html

Primary: docxSource: application/vnd.openxmlformats-officedocument.wordprocessingml.document

Loading document viewer…

Document Metadata

File Type	application/vnd.openxmlformats-officedocument.wordprocessingml.document
File Title	EvaluationWeb screen shots
Author	Carolyn Wright
Last Modified By	Writer
File Modified	2025-12-03
File Created	2026-06-04
Conversion State	complete

Extracted Text

Agency information:

Client information: Local Client ID# is not reported to CDC.

HIV test information:
              
                                                                        
            

Negative test result




Positive test result


Additional test information

PrEP

Essential Support Services