Imagine Hope HCV Monthly Report
Please fill out by the 5th of each month
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January
February
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September
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Agency Name
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Access Point
Advantage BHS
Alliance Recovery Center/Athens
Alliance Recovery Center/Conyers
Alliance Recovery Center/Decatur
Ascensa/St. Jude's
Aspire
Avita Community Partners
Bridge Health
Brunswick Judicial Drug Court
CaringWorks
Clayton Center
Coastal Community Behavioral Health
CSB of Middle GA/Quentin's Place
DeKalb County CSB/Claratel
DM & ADR
Gateway BHS
Gateway Treatment Services
Georgia Treatment Services
HealthQuest/Savannah
Highland Rivers Health
Highland Rivers Health/Cobb
Imagine Hope - Barbara
Imagine Hope - Sam
Imagine Hope - Sheila
Imagine Hope - YO
Lanier Treatment Center
Legacy BHS
Med-Mark Treatment Centers/Chatsworth
Mercy Ministries/Graham
Mercy Ministries/Lyons
McIntosh Trail
Middle Flint
New Horizons CSB
North Fulton Treatment Center
Pathways CSB
Pineland
Pinnacle
Pittard Clinic
Recovery Place
Reliance Treatment Center of Statesboro
Ringgold Treatment Center
The Forge
Toombs County Prevention, Treatment & Recovery
Unison Behavioral Health
Unison MAT
View Point Health
Walton County Treatment
Westcare of Georgia
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Name
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First Name
Last Name
Cell Number
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Format: (000) 000-0000.
Email
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HCV Data
Number of HCV RAPID Antibody Tests Performed
*
Number of HCV Serum-based Antibody Tests Performed
*
Total number of HCV Antibody Tests Performed
This will calculate automatically
Total number of HCV Antibody Tests Performed During Outreach
*
TOTAL number of Test Results that were Ab-positive
*
Total Number of RNA Tests [If not = to TOTAL number of Ab+ results (above) please explain below]
*
If your total number of RNA tests does not = total number of Ab+ results, please list name(s) of client(s) not yet RNA tested and explain:
*
Total number of RNA positive test RESULTS
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Total Number of RNA+ Clients Entered into REDCap
*
Total Number of RNA+ Clients 360 Releases Collected / Uploaded to REDCap
*
List all clients who tested RNA NEGATIVE this Month
Upload any relevant ROIs for Ab+/RNA- Clients
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List clients who tested RNA POSITIVE this Month
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