HIV/AIDS Counselor ID Request Form

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Counselor ID Request Form

Kansas HIV/AIDS Program

All Counselor ID requests are completed in the order in which they are received. Please allow up to a week for processing.

* Denotes required fields.

* Note -  In order to submit a request for these records online a FAX number and email address is necessary.

 Comments or Questions:

( * At least one selection below is required before submittal. )

* Select the ones that apply to you: I administer HIV testing through.

Questions: Contact Stephanie Green at (785) 296-5595 and the fax is (785) 296-5590.