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PRACTITIONER REMEDIATION ENHANCEMENT PROGRAM
PREP EMPLOYER/SELF REFERRAL FORM
Please submit referral form to: Pamela Trondheim, PREP Coordinator
North Carolina Board of Nursing
P. O. Box 2129
Raleigh,
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How to fill out prep referral form
How to fill out prep referral form
01
To fill out a prep referral form, follow these steps:
02
Start by entering the client's personal information, including their name, contact details, and date of birth.
03
Provide information about the client's demographics, such as gender, race, and ethnicity.
04
In the medical history section, record any relevant medical conditions, allergies, or ongoing medications.
05
Indicate the reason for the referral, specifying that it is for pre-exposure prophylaxis (PrEP).
06
Include any additional notes or comments regarding the client's eligibility or specific circumstances.
07
Finally, review the form for accuracy and completeness before submitting it for further processing.
Who needs prep referral form?
01
The PrEP referral form is typically required for individuals who are seeking pre-exposure prophylaxis (PrEP) as a preventive measure against HIV infection.
02
This form is commonly used by healthcare providers, clinics, or organizations involved in offering PrEP services.
03
It may also be required for individuals who meet certain criteria for PrEP eligibility as determined by healthcare guidelines.
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What is prep referral form?
The prep referral form is a document used to refer individuals to pre-exposure prophylaxis (PrEP) services for HIV prevention.
Who is required to file prep referral form?
Healthcare providers and organizations that offer PrEP services are required to file the prep referral form.
How to fill out prep referral form?
The prep referral form can be filled out by providing the necessary information about the individual being referred and the reason for the referral.
What is the purpose of prep referral form?
The purpose of the prep referral form is to facilitate access to PrEP services for individuals at risk of HIV infection.
What information must be reported on prep referral form?
The prep referral form must include the individual's demographics, risk factors for HIV infection, and the healthcare provider's information.
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