Decision No. 868/2005/QĐ-BYT on seven forms for HIV laboratories issued by the Minister of Health

This Decision promulgates seven forms for HIV laboratories to be applied at state-owned, private, and public-private joint venture healthcare facilities with the aim of standardizing the management of patient samples and HIV test results.

文号868/2005/QĐ-BYT
文件类型Decision
发布机关Ministry of Health
签署人Trần Chí Liêm — Thứ trưởng
更新12/06/2026
行业Health
领域PreventionHIV/AIDS Prevention
发布日期29/03/2005
生效日期29/03/2005
失效日期27/04/2018
状态Expired
✦ 智能摘要

This Decision promulgates seven forms for HIV laboratories to be applied at state-owned, private, and public-private joint venture healthcare facilities with the aim of standardizing the management of patient samples and HIV test results.

适用范围

HIV laboratories in state-owned, private, and public-private joint venture healthcare facilities

要点

  • HIV laboratories must use the promulgated forms for their intended purposes (Article 3).
  • All columns in the forms must be fully completed with information, the conclusion section must be clearly written in letters without erasure or alteration (Article 3).
  • The Central Institute of Hygiene and Epidemiology and regional institutes are responsible for periodically checking the implementation of this regulation annually (Article 4).
  • The forms include: HIV Test Sample Submission Form, HIV Test Result Registration Book, HIV Testing Record Book, Positive and Suspected Sample Storage Book, HIV Test Result Response Form, HIV Test Results, HIV Test Result Appointment Form.
  • The forms must be used for their intended purposes and fully completed with information.

🌐 本文件的社会影响

  • A unified approach to managing patient samples and HIV test results enhances the quality of healthcare services in HIV prevention.
  • It helps healthcare facilities comply with regulations and ensure the accuracy of information during the HIV testing process.

❓ 常见问题

Who are these forms for?

These forms are issued for use by HIV laboratories at state-owned, private, and public-private joint venture healthcare facilities.

What should be done if there is an error in the information on the form?

If there is an error in the information, it should be crossed out and rewritten on the next line.

全文

MINISTRY OF HEALTH
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
---------------

Number: 868/2005/QĐ-BYT

Hanoi, March 29, 2005

 

Pursuant to …;

REGARDING THE ISSUE OF SEVEN FORMS FOR HIV TESTING LABORATORIES

THE MINISTER OF HEALTH

Pursuant to Decree No. 49/2003/NĐ-CP dated May 15, 2003 of the Government stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health,

At the proposal of the Director of the Preventive Medicine Department and HIV/AIDS Prevention and Control Department,

Pursuant to …;

Article 1. The seven forms attached hereto are hereby issued for HIV testing laboratories.

Article 2. These forms shall be applied to HIV testing laboratories in state, private, and public health facilities.

Article 3. The forms must be used for their intended purposes. All columns in the forms must be filled out completely, with the conclusion section clearly written in full (negative or positive or inconclusive), without erasing or altering entries. If there is an error, the incorrect line should be crossed out and rewritten on the next line.

Article 4. The Central Institute of Hygiene and Epidemiology and regional institutes are assigned responsibility for inspecting the implementation of this Decision's provisions regarding HIV testing laboratories within their respective regions annually.

Article 5. This Decision takes effect from the date of signature and issuance.

Article 6. The following individuals are responsible for implementing this Decision: the Director of the Office, the Director of the Preventive Medicine Department and HIV/AIDS Prevention and Control Department, Heads of relevant Departments at the Ministry of Health, Heads of subordinate units under the Ministry of Health, Directors of Provincial Health Services, Heads of Health Departments of various sectors, and Heads of state, private, and public health facilities.

 

 

DEPUTY MINISTER OF HEALTH
DEPUTY MINISTER





Tran Chi Lien

 

SEVEN FORMS FOR HIV TESTING LABORATORIES.

BM 1 SAMPLE SUBMISSION FORM FOR HIV TESTING

BM 2 RECORD BOOK FOR RECEIVING AND RETURNING HIV TESTING RESULTS

BM 3 HIV TESTING RECORD BOOK

BM 4 RECORD BOOK FOR POSITIVE AND SUSPECTED HIV SAMPLES

BM 5 RESULT RETURN FORM FOR HIV TESTING (For the unit sending samples for HIV testing)

BM 6 HIV TESTING RESULTS (To be returned to the person undergoing HIV testing)

BM 7 RESULT RETURN APPOINTMENT FORM

 

BM 1 SAMPLE SUBMISSION FORM FOR HIV TESTING

DEPARTMENT OF HEALTH
Sending unit:...
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
---------------

 

Date...Month...Year 201...

 

SAMPLE SUBMISSION FORM FOR HIV TESTING

Serial number

NAME / ID NUMBER

YEAR OF BIRTH

DATE OF SAMPLE COLLECTION

OCCUPATION / CATEGORY

BAR CODE

TESTS PERFORMED

REMARKS

 

 

YEAR

FEMALE

 

 

 

SP1

SP2

SP3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Note: Clearly write the names of the reagents tested:

Reagent 1...Reagent 2...Reagent 3...

 

Sample Receiver
(sign and write name)
 

Sample Sender
(sign and write name)

Testing Supervisor
(sign and stamp)

 

BM 2 RECORD BOOK FOR RECEIVING HIV TESTING SAMPLES

DEPARTMENT OF HEALTH

Unit:...

DEPARTMENT OF TESTING...

 

 

RECORD BOOK FOR RECEIVING AND RETURNING RESULTS

year 201...

 

 

 

 

Serial number

UNIT - SECTION SENDING SAMPLES

DATE OF SAMPLE SUBMISSION

NUMBER OF SAMPLES

SAMPLE SUBMITTER

SAMPLE RECEIVER

DATE OF TESTING

DATE OF RESULT RETURN

RESULT RETURNER

RESULT RECEIVER

REMARKS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BM 3 HIV TESTING RECORD BOOK

DEPARTMENT OF HEALTH

Unit:...

DEPARTMENT OF TESTING...

 

 

HIV TESTING RECORD BOOK

FROM...TO...YEAR 201...

 

 

 

 

Serial number

DATE OF SAMPLE RECEIVED

NAME / ID NUMBER

YEAR OF BIRTH

OCCUPATION / CATEGORY

UNIT - SECTION SENDING SAMPLES

TESTS PERFORMED

CONCLUSION

REMARKS

 

 

 

YEAR

FEMALE

 

 

SP 1

DO / CO

SP2

DO / CO

SP3

DO / CO

OTHER TESTS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BM 4 RECORD BOOK FOR POSITIVE AND SUSPECTED HIV SAMPLES

DEPARTMENT OF HEALTH

Unit:...

DEPARTMENT OF TESTING...

 

 

RECORD BOOK FOR STORING POSITIVE AND SUSPECTED HIV SAMPLES
POSITIVE AND SUSPECTED

 

year 201...

 

 

 

 

Serial number

NAME / ID NUMBER

YEAR OF BIRTH

ADDRESS

OCCUPATION / CATEGORY

TESTING RESULTS

CONCLUSION

REMARKS

 

 

 

 

 

 

SP1

SP2

SP3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

BM 5 RESULT RETURN FORM FOR HIV TESTING

(For the unit sending samples for HIV testing)

DEPARTMENT OF HEALTH
Sending unit:...
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
---------------

 

Date...Month...Year 201...

 

Respectfully submitted to:...

RESULT RETURN FORM FOR HIV TESTING

Place sending sample for testing:...

Date sending sample for testing:...

Date of testing:...

Serial number

NAME / ID NUMBER

YEAR OF BIRTH

ADDRESS

OCCUPATION / CATEGORY

TESTING RESULTS

CONCLUSION

REMARKS

 

 

 

 

 

 

SP1

SP2

SP3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HEAD OF THE UNIT
(sign and stamp)

RESPONSIBLE TESTING DEPARTMENT
(sign and stamp)




 

 

BM 6 HIV TESTING RESULTS

(To be returned to the person undergoing HIV testing)

 

DEPARTMENT OF HEALTH
HO CHI MINH CITY

UNIT …………………..

TELEPHONE...

HIV TESTING RESULTS

Date of sample submission:...
Place of submission:...

Test code:...

Patient's name:...Age:......Gender: Male......Female......

Address:...Type of specimen:...

Testing request:...

Result:...

-

-

-

Conclusion:………………………………………………………………………………………………

Confirmatory test date:...

Recommendation:                                    Consultation

 

Credit organization branch in province/city and basic credit cooperative…

Date...Month...Year 20...
Head of Testing Department
 

 

BM 7 RESULT RETURN APPOINTMENT FORM

DEPARTMENT OF HEALTH
Sending unit:...
-------

SOCIALIST REPUBLIC OF VIET NAM
Independence - Freedom - Happiness
---------------

 

RESULT RETURN APPOINTMENT FORM

Patient's name:...Date of birth:...

Blood draw date:...

Date of result return:...

Contact number (testing department phone number): ...

 

 

Date...Month...Year 201...
Blood drawer
(sign and write name)
 

 

 

 

 

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