Form

HIV reference test referral form

Diagnostic request form (S3) for HIV.

• From: UK Health Security Agency
• Published: 1 April 2014
• Last updated: 7 July 2023
  Show all updates

  1. 7 July 2023

     Updated referral form.

  2. 4 January 2023

     Added new version of HIV reference test request form.

  3. 25 May 2021

     Uploaded new HIV reference test request form.

  4. 23 October 2018

     Updated page to simplify the 'clinical and epidemiological information' section. In addition, added information on PreP exposure.

  5. 1 April 2014

     First published.

Documents

S3: HIV reference test request form

Ref: UKHSA publications gateway number GOV-14958

PDF, 1.07 MB, 1 page

This file may not be suitable for users of assistive technology.

Request an accessible format

If you use assistive technology (such as a screen reader) and need a version of this document in a more accessible format, please email publications@ukhsa.gov.uk. Please tell us what format you need. It will help us if you say what assistive technology you use.

Details

Send completed form with clinical samples to:

Virus Reference Department (VRD)

UK Health Security Agency
61 Colindale Avenue
London
NW9 5HT

Email vrdqueries@ukhsa.gov.uk

Telephone 0208 327 7887

DX address UKHSA Colindale VRD, DX 6530006

Specimen submission guidelines are available in the VRD user manual