paper_forms

US-Mexico Border Health Evaluation and Technical Assistance Center

PAPER DATA ENTRY FORMS*
(for scanning and faxing to Oklahoma)

Multi-site Evaluation		*English*	*Spanish*
A	Demographics	A -- demographics	A -- demográficos
B	Life-style & culture	B -- lifestyle	B -- estilo de vida
C	Change form	C -- change	-
D	Risk factors	D -- risk factors	D -- factores de riesgo
E	Quality of life	E -- quality of life	E -- calidad de vida
F	Barriers to HIV/AIDS medical care	F -- barriers	F --barreras
G	Client satisfaction	G -- client satisfaction	G -- satisfacción del cliente
Local Evaluation		*English*	*Spanish*
1	Social support	1 -- social support	1 -- apoyo social
2	Outreach Demographics	2 -- outreach demographics
3	Outreach Contact	3 -- outreach contact
4	Testing Demographics	4 -- testing demographics	4 -- pruebas demográficos
5	NMX Outreach Demographics	5 -- nmx outreach demographics
6	NMX Outreach Contacts	6 -- nmx outreach contacts
7	AETC Clinician Assessment	7 -- aetc clinician assessment
8	AETC Provider Assessment	8 -- aetc provider assessment
9	Hispanic Stress Inventory	9--hispanic stress inventory	9--inventario de estres para hispanos
10	Health Services Scale	10--health services scale
11	CAL HIV Testing Results	11--CAL HIV Testing Results
12	CAL Risk	12--cal risk.pdf	12--cal - factores de riesgo
13	NMX Risk	13--nmx risk.pdf	13--nmx - factores de riesgo

*requires Adobe Acrobat Reader for printing of forms