Generic Clinic Forms

These PDF file are generic versions of clinic forms developed by i-Base and the Royal Free Centre for HIV Medicine.

Some forms have space for patient stickers and for a hospital or clinic logo to be added to from your own clinic or health Trust.

If you have any difficulty with these forms, or would like help adapting them for your Trust, please contact i-Base.

Double-sided sheet for patients to record when they have taken their medication and on the reveres side a side effects diary.

Uses this file if you have a printer that can print on both sides of the paper
Download PDF File [36 Kb]

Single-sided sheet for patients to record when they have taken their medication to help improve adherence.

Uses this file if your printer can only print on one side of the paper
Download PDF File [20 Kb]

Single-sided sheet for patients to use to record any changes in their health that could be related to side effects

Uses this file if your printer can only print on one side of the paper
Download PDF File [64 Kb]

Single-sided sheet for patients to graph their CD4 and viral load results, and to explain when to start treatment.
Download PDF File [80 Kb]

Single-sided sheet for recording a patients cardiovascular risk factors.
Download PDF File [36 Kb]

Single-sided sheet for recording hepatitis A/B/C status annually.
Download PDF File [36 Kb]

Single-sided sheet for recording patient notes when seen as a day case.
Download PDF File [16 Kb]

Six-page document for recording more detailed notes when seeing a patient for the first visit.
Download PDF File [60 Kb]

Single-sided annual summary including lab results.
Download PDF File [44 Kb]

Single-sided sheet summarising changes in ARV treatment.
Revised Apr 08
Download PDF File [40 Kb]

2-sided sheet for collecting voluntary information about patient ethnicity.
Download PDF File [116 Kb]