IDU and Other Drug Protocol Form

Human Services Block Grant Data Tracking IDU

Instructions

IDU and other drug protocol data additional notes

1. # of individuals who came in for testing / total # of contacts (cards provided) Recall that if an individual with a card comes in for testing and brings three others with them, they should all be counted (3, not 1).

2. Please provide historical data, meaning that we would like you to go back a few years (4-5 if possible) to provide these values so that we can establish a baseline. Research on this is lacking and it is difficult to find reasonable base rates.

3. Percentage (%) of clients that came in for testing, divide number in #2 (total number who came for testing) by #1 (Total number of contacts).

Person completing form - Contact information.

First Name

Last Name

Phone

Provider Name

Select Month

Select Year

Total Number of Contacts

Total Number of those who came in for testing

Percentage of contacts that came in for testing