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STATE OF WASHINGTONDEPARTMENT OF HEALTH CLIENT SERVICES EARLY INTERVENTION & PREEXPOSURE PROPHYLAXIS PROGRAM APPENDIX B PAGE 1 Please complete one box below for each additional clinic that bills under the contracting Tax ID Number. If more pages are needed, you may copy this page. ADDITIONAL CLINIC INFORMATION Facility Name: Facility Address: City:State:Main Contact Name:Appointment Number:Email Address:Clinic Fax Number:Services Offered at this Location:Zip: Medical
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How to fill out early intervention pre-exposure prophylaxis

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How to fill out early intervention pre-exposure prophylaxis

01
Obtain a prescription from a healthcare provider knowledgeable about PrEP.
02
Schedule a baseline HIV test and other relevant screenings (e.g., kidney function).
03
After receiving a negative HIV test result, begin taking PrEP medication as prescribed.
04
Follow up with your healthcare provider every 3 months for ongoing HIV testing and prescription refills.
05
Discuss any side effects or concerns with your healthcare provider during follow-up visits.
06
Maintain regular testing for other sexually transmitted infections (STIs).

Who needs early intervention pre-exposure prophylaxis?

01
Individuals with an HIV-positive partner.
02
Those who engage in high-risk sexual behaviors.
03
People with multiple sexual partners.
04
Individuals who have been diagnosed with a sexually transmitted infection (STI) within the past six months.
05
Injection drug users or people who share needles/syringes.
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Early intervention pre-exposure prophylaxis (PrEP) is a preventive health strategy that involves administering medication to individuals who are at high risk of contracting a specific infection, such as HIV, to significantly reduce their chances of infection.
Individuals at high risk for HIV, such as those with multiple sexual partners or those with an HIV-positive partner, are typically required to file for early intervention pre-exposure prophylaxis.
To fill out the early intervention pre-exposure prophylaxis form, individuals should provide personal details, risk assessment information, medical history, and any previous exposure to HIV testing results.
The purpose of early intervention pre-exposure prophylaxis is to prevent the transmission of HIV by providing effective antiretroviral medication to those who are at higher risk.
The information that must be reported includes personal identification details, risk factors for HIV exposure, previous HIV test results, and any current medications being taken.
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