Case Report Forms

Adobe Acrobat Reader is Required to download and read the forms:
Download Adobe Acrobat Reader

Patient Log

To assure patient confidentiality, patient identifiers are not collected by the Registry, rather the Registry assigns a number. The Patient Log is a suggested means to link the Registry ID with the provider’s identification for patients enrolled in the Registry.
(This form is NEVER returned to the Registry.)

Click here to contact the Registry to request Log ID Assignments.
Registration and Antiretroviral Therapy During Pregnancy Forms

Click here to download the Registration Form and Antiretroviral Therapy During Pregnancy Form.

Call or Email (SM_APR@APRegistry.com) the Registry to obtain a Patient Log ID number.

Complete the Registration Form and relevant exposure information on the Antiretroviral Therapy During Pregnancy Form and

Email (SM_APR@APRegistry.com) or Fax Registration forms to the Registry to provide the information.
Follow-up Form

Click here to download the Follow-up Form.

Collect information on the outcome of pregnancy and description of any birth defects identified.
Complete both the Follow-up and Updated Antiretroviral Therapy Forms

Email (SM_APR@APRegistry.com) or Fax forms to the Registry.
Updated Antiretroviral Therapy During Pregnancy Form

Click here to download the Antiretroviral Therapy During Pregnancy Form.

A copy of this form will need to be updated and returned to the registry with the Follow-up Forms.
Targeted Follow-up Form

If a defect is noted, additional information related to the defect will be requested.