Ryan White | Early Intervention Services Informed Consent

Patient’s Responsibility

• Provide information on sexual lifestyle, medical history, and drug use
• Complete a risk assessment
• Adhere to lab work, frequent assessments, and care plan
• Work with case management team and other HIV resources
• Adhere to follow-ups and eligibility requirements

Program Advantages

• Medical assessments at regular intervals
• Laboratory tests
• Health education, HIV/AIDS prevention, and risk reduction information
• Case management, counseling and emotional support
• Referrals and other support services

Case Management Support

Case management is a vital part of a holistic approach of serving those who are HIV positive. Case management will give you a voice, understanding, and confidence.

Confidential Records

Special care will be taken to protect every patient’s confidentiality. Patient’s records will be shared only with a written consent.

Consent to Participate in Case Management Program

By my signature below, I consent to be enrolled in PanCare’s Early Intervention Services (EIS) Case Management Program and to participate in all required components of the program for which I am eligible.