# Presentation: 267873

## The Interview Record

**The Interview Record**

- Released 2007

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## Directions

- Prior to beginning this program it is highly recommended that you have printed copies of the ***Interview Record***, the ***Instructions*** and the ***Codes List*** available for review as you go through this training.

## Directions

- Advance through this training program by using your mouse to click the “NEXT” button in the lower right-hand corner of each slide. _Do NOT use the keyboard to advance through this training as it will cause links to work improperly_.
- Click on any red shaded fields to see information about the shaded field.

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## Directions

- To return to your previous screen, click on the green back-button in the upper right hand corner.
- Click on this symbol to see what impact this section might have on the interview.
- Watch for important “Special Note” boxes throughout the program.

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**Special Note:  ....**

## Directions

- To close this program press the ESCAPE or ESC key on your keyboard.

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## Goals of Interview Record:

- To improve the quality of information gathered in order to enhance disease intervention efforts.
- To incorporate standardized variables for improved data collection and analysis of patient behaviors.
- To provide a single standardized form for the management of STD and HIV cases.

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## Benefits of the 2007 Interview Record

- Reduces the number of case management forms by incorporating the Original Patient Information Sheet into the Interview Record.
- Improves HIV/AIDS case management through more comprehensive data collection and analysis.
- Ensures complete and consistent gathering of case information for improved intervention outcomes.

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## Benefits of the 2007 Interview Record

- Dedicated area for interviewer comments.
- Devoted spaces for DIS’ case management plans and supervisor’s comments.
- Updated variables to better relate to current trends in STD/HIV cases.

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## ?

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**Menu**

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- F A Q s

**Click on any PAGE to begin.**

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## Slide 11

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## Fields located on the right-hand side of page 1 help locate a specific record when more then one case is filed in the same Lot.

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## The Patient ID

- Document the patient ID number for this person

**Special Note:  The Patient ID will be a locally generated identification number. It may be the patient’s medical record number or clinic number. Each program will determine what will be used for this field.**

## Conditions

- Document the specific code(s) for the condition(s), or diseases, interviewed and/or diagnosed

**Special Note 2:  Space is provided for two conditions to be documented should the patient being interviewed be diagnosed with two infections.**

**Special Note 1:  Codes for the Condition(s) field, as well as all other codes fields, can be found on Codes List. **

## Neurological Involvement:

- Document the appropriate response: Yes – **C**onfirmed, Yes – **P**robable, **N**o, or Unknown

## Case ID

- Document the case ID number for the corresponding conditions

**Special Note:  Case IDs or numbers will continue to be determined and assigned by local programs.**

## Lot #

- Locally assigned number utilized by the Lot System in order to group related cases for better case management.

**Special Note:  Related cases should share the same Lot Number.**

## Interview Record ID 

- Interview Record ID
- Document the interview record number for this case.

**Special Note:  This is frequently used by computer systems for linking cases within a database.**

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## Name

- Document the patient’s  last, first and middle names, including known  aliases or nicknames

## Address

- List complete address where the patient _*currently resides*_.  Make sure to include apartment number, city county, state and zip code

**Special Note: If currently institutionalized (jail, group home, mental health facility, etc) do not document the address unless the condition was acquired there**

## Living With

- Document the relationship(s) of those living with the patient. (spouse, sibling, roommate, parents, etc.)

**Special Note:  The names of those identified in this area should be documented in the Interview Comments section on page 5.**

## Residence Type

- Residence Type
- List appropriate code for type of residence for the address listed above

## Time At Address

- Document the length of time the patient has lived at the current address in (w) weeks, (m) months, or (y) years

**Special Note:  If the patient has lived at more than one location during the Interview Period, other addresses are to be documented in the Interview/Investigation Comments section of the Interview Record.**

## Currently Institutionalized?

- Mark appropriate box, Y-yes, N-No, U-Unknown.  List the name of the facility and type of institution

## Phone/Contact

- List *all* phone numbers where the patient might be reached including any email addresses.  Include emergency contact name, phone number and relationship to patient

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## Date of Birth

- Document the patient’s date of birth

- Age
- Document the patient’s age at the time of initial exam for the earliest condition reported on this interview record.
- Document ‘0' if age is less than one year or ’999' if unknown.

## Sex at Birth and Current Gender

- Indicate the patient’s gender at birth as well as what gender the patient currently  identifies him/herself

## Marital Status

- Mark appropriate box indicating martial status at the time of the interview or morbidity report

## Hispanic or Latino

- Mark appropriate box to identify  the ethnic group the patient *self identifies *

## Race

- Mark _as many boxes as applicable_  which the patient *self identifies*

## English Speaking?

- Mark the appropriate box to indicate if the patient can speak/understand English.
- Document the patient’s primary language if it is not English

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## Pregnant at Exam

- Mark appropriate box to indicate the patient’s pregnancy status at initial exam.  If the patient was pregnant at the time of the initial exam document duration of pregnancy in weeks.

**Special Note:  If the patient’s condition is syphilis and she answers ‘Yes’ to this question, complete the Congenital Syphilis Form according to local practices/procedures.**

## Pregnant at Interview

- Mark appropriate box to indicate the patient’s pregnancy status at the time of
- Interview. If the patient was pregnant at the time of the interview,
- document the duration of the pregnancy in weeks at interview. If the duration of the pregnancy is not known, document
- the patient’s best estimate.

**Special Note:  If the patient’s condition is syphilis and she answers ‘Yes’ to this question, complete the Congenital Syphilis Form according to local practices/procedures.**

## Currently in Prenatal Care?

- Mark appropriate box to indicate whether the patient is receiving/received
- prenatal care for this pregnancy.

## Pregnant in the Past 12 Months

- Determine if the patient has been pregnant during the last 12 months and place an “X” in
- the appropriate box.

**Special Note:  If currently pregnant, a “Yes” answer indicates that the patient had **_***another***_** pregnancy within the past 12 months, not including her current pregnancy.**

## Pregnancy Outcome

- If pregnant in the last 12 months, place an “X” in the appropriate box to indicate the outcome of
- that pregnancy.

## Page 1

**Special Note:  For patients with two conditions, space is provided to document key information about each condition.**

**Condition**
**1**

**Condition**
**2**

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**Condition 1**

**Condition 2**

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## Method of Case Detection

- For each condition, use the appropriate code from the code list to document how the patient first came to the attention of the health department.

## OP Condition

**OP Condition**
- If _*Patient Referred Partner, Health Department Referred Partner, or Cluster Related*_ is selected as Method of Case Detection, indicate the Index patient’s Condition Code (i.e., 710, 720, etc.) and Case ID Number in the space provided if known.

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## Type Facility First Tested

- Document the specific type of facility code where the patient was first tested for each condition.

## Date of Laboratory Report

- Document the date that the first _*laboratory*_ report related to each  condition was received.

**Special Note:  If subsequent lab results are available, they should be documented on page 3 in the STD Testing section.**

## Interviewed?

- Mark appropriate box
- if patient was not interviewed and  document the specific reason why.

## Interviewed Period

- Record the Interview Period in whole months. If the Interview Period used had a part of a month (Primary Syphilis – 4 months and 1 week) round UP to the next full month.

## Place of Interview

- Mark specific location code where the interview took place for each condition

## PEMS ID

- Document the PEMS site ID of the location of the original interview.

**Special Note:  This field is for HIV/AIDS cases only**

## Date First Assigned for Interview

- Mark the date the case was initially assigned for interview and the worker number of the DIS to whom it was assigned for each condition

## Date Reassigned for Interview

- If the case is reassigned to another DIS, indicate the date the case was reassigned for interview and the worker number of the new DIS to whom it was reassigned.

## Date Original Interview

- Document  the date of the initial interview and the worker number of the DIS that performed the interview for each condition

## Date First Re-Interview

- Document the date for the first re-interview and the worker number of the DIS that performed the re-interview for each condition

**Special Note:  ALL re-interview should also be documented on page 4 with the names of the partners and suspect initiated during each re-interview. If no partners or suspects were initiated, NCI (for No Contacts Initiated) should be written in the field for Name.**

## Date Case Closed

- Document the date of case closure along with the worker numbers of the investigating DIS and Supervisor

## Imported Case

- Place an “X” in the appropriate box imported case refers to a case that was acquired outside the jurisdiction where the patient resides. If the case was imported, list city, county, state, and/or country

**Special Note:  An example might be a primary case of syphilis who moved to the area just two weeks ago.**

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## Local Use

- Area provided for special data collection needs of individual program areas

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## Page 2

##  Risk Factors - Sexual Behaviors

-  Risk Factors - Sexual Behaviors
- Document the appropriate response for each question

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## Page 2

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## Risk Factors - Drug Use Behaviors

- List the appropriate response for each question

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## Page 2

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## Other Risk Factors

- List the appropriate response

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## Page 3

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## Test Results

- Summarize all STD lab results relevant to this case in chronological order including the provider and specimen source.

**Special Note:  HIV testing is *****NOT***** documented here.**

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## Page 3

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## Tested for HIV at this event?

- Place an “X” in the appropriate box indicating if the patient was tested for HIV at the time of the initial screening that led to this reported condition(s)

## Previously Tested for HIV?

- Place an “X” in the appropriate box if the patient has tested for HIV prior to the event that led to the Original Interview

## HIV Test Results

- Current and previous HIV testing information is to be documented here.

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## Signs and Symptoms

- List all symptoms experienced by the patient and observed by the clinician
- Include the date signs and symptoms began and anatomical site(s)

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## Page 3

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## STD History

- Place an “X” in the appropriate box
- If yes, document the condition code, diagnosis and treatment date

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**Special Note:  HIV testing history should not be documented here.**

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## Treatment

- Document all relevant treatment regimen(s) including the date, provider, drug and dosage

## Incidental Antibiotics Treatment in Last 12 Months

- Place an “X” in the appropriate box and list the date, drug, dosage, duration and condition for which the antibiotic was prescribed.

## Anti-Retroviral Therapy for Diagnosed HIV Infection?

- Indicate therapy in the past 12 months in the appropriate box then indicate if the patient ever had anti-retroviral therapy

## HIV Counseling at this event?

- Place an “X” in the appropriate boxes for Pre and Post Test Counseled

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## Place Met Partners

- Document the codes for the types of places where the patient _***met***_ sex partners
- List names or descriptions of places the patient goes to meet sex partners

## Places had Sex

- Document the codes and descriptions for the types of places where the patient had sex with partners

## Partners in the Last 12 Months

- Document the number of female, male, and transgender partners claimed by the patient

**Special Note:  **This includes initiated partners, marginal partners, and anonymous partners. Select ‘unknown’ if patient is unsure or ‘refused’ if the patient would not answer the question. Document “0” if there are no partners for corresponding gender field.

## Interview Period Partners

- Document the total number (includes initiated partners, marginal
- partners, and anonymous partners) of female, male, and transgender sex partners claimed during the established Interview Period

## Page 4

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## Partner/Custer Information

- Space is provided to document information on up to 5 Partners and/or Clusters who are initiated.

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**Special Note 2:  Marginal Partners (those partners with insufficient information to initiate) should NOT be documented here. Space for Marginal Partners is provided on Page 5.**

**Special Note 1:  If more than 5 partners, suspects or associates are initiated, another copy of Page 4 should be used.**

## Special Note:  Along with partners and suspects initiated from the Original Interview, Re-interview and cluster activities should be documented (each in a separate section).

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**Contact** Initiated from **Original Interview**

**Contact** Initiated from **Original Interview**

**Suspect** Initiated from **Original Interview**

**Associate** Initiated from **Cluster Interview**

**Contact** Initiated from **Re-Interview**

**Special Note:  Along with partners and suspects initiated from the Original Interview, Re-interview and cluster activities should be documented (each in a separate section).**

**Special Note:  Clusters must be identified specifically during an interview activity (Original Interview, Re-interview, or Cluster Interview). Those identified from field screenings or other screening events should not be initiated as clusters.**

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## Name

- Document the Last and First name, including aliases, if known

## Jurisdiction

- Document the county, state or county code or name for where the partner/cluster resides

## P/CI 

- P/CI
- Document the appropriate identifier code for type of Partner or Cluster

## Exposure to Original Patient

- Document the date of the first and last sexual/needle-sharing exposure and frequency to the index patient.

## Sex of the Partner or Cluster

- Place an “X” in the appropriate box to indicate the gender of partner or cluster as identified by the person being interviewed

## Pregnant

- Document if this partner/cluster is identified as being pregnant

## Spouse

- Document if this partner/cluster is the Index patient’s spouse

## IX Date

- Document the date the original interview, re-interview or cluster interview was performed

**Special Note:  Information documented in this section for Condition 1 and Condition 2 should correspond with Condition 1 and Condition 2 from Page 1.**

## Init. Date (Initiation Date)  

- Init. Date (Initiation Date)
- Document the date this partner/cluster was initiated for field investigation

## IX DIS (Interview DIS) 

- IX DIS (Interview DIS)
- Document the worker number of the DIS who conducted the interview for each condition

## IX Type (Interview Type)  

- IX Type (Interview Type)
- Document the type of interview that was the source of the partner/cluster information

## Referral

- Indicate how initiated partners and clusters are brought to examination and/or treatment.

## FR # (Field Record Number)  

- FR # (Field Record Number)
- Document the entire field record number(s) for the partner/cluster initiated.  The number may be generated by a software system

## Dispo (Disposition)

- Document the STD or HIV disposition code from the field record for each condition

- Dispo Date (Disposition Date)
- Document the appropriate date as it relates to the examination or treatment situation for each condition

## Cond (Condition)

- If partner/cluster is dispositioned as infected, previously or currently, document the diagnosis code for the condition

## DIS #

- Document the worker number of the DIS who brought this partner or cluster to disposition for each condition

## SO/SP  (Source/Spread)

- Document “SO” for source of condition for the index patient or “SP”  for spread from the index partner

**Special Note 1:  Source or spread should only be documented for *****infected *****partners.**

**Special Note 2:  If partner condition is not related to the Index patient, document “U” (Unrelated) in the box. If it is unknown whether a partner condition is related to the Index patient, document “UN” (Unknown) in the box. Do not mark a box if adetermination has not been made.**

## Page 5

## Marginal Partners

- Document the name, sex, age, race, height, weight, hair (description) exposure history, and location information for those partners named by the index patient with limited information to initiate

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## Page 5

## Interview/Investigation Comments

- Document any additional information not included in the interview record, such as the attitude of the patient and/or note any inconsistencies during the interview

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## Page 5

## Travel History and Internet Use

- Document travel that occurred within the interview period, include place, dates, reason for travel and companions.  Also document any related internet use information such as email addresses and user names

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## Page 6

## Date Submitted

- Document the appropriate date when the DIS submitted the Interview Record for initial review to supervisor

- Initial Review Date
- Document the appropriate date when the DIS Supervisor initially reviewed the Interview Record

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## Page 6

## DIS Investigation Plans

- Record future planned actions including worker number and date.  Each plan of action by the DIS and/or response to supervisory comments should be dated and documented.

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## Page 6

## Supervisory Comments

- The initial review and subsequent reviews by the supervisor and/or response to DIS comment(s) should be dated and documented

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## Congratulations!

- You have completed the training for the 2007 version of the Interview Record. We recommend that you keep a copy of the *Instructions *and *Codes* readily available for quick reference.

##  INTERVIEW IMPACT 

**Interview Format**
**Introduction**
**Patient Assessment**
**Disease Intervention Behaviors**
**Conclusion**

##  INTERVIEW IMPACT 

**Interview Format**
**Introduction**
**Patient Assessment**
**Disease Intervention Behaviors**
**Conclusion**

##  INTERVIEW IMPACT 

**Interview Format**
**Introduction**
**Patient Assessment**
**Disease Intervention Behaviors**
**Conclusion**

##  INTERVIEW IMPACT 

**Interview Format**
**Introduction**
**Patient Assessment**
**Disease Intervention Behaviors**
**Conclusion**

## Frequently Asked Questions

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