HIV Provider Welcoming Assessment - Rainbow Health

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HIV Provider Welcoming Assessment

The following questionnaire was developed using The Centers for Disease Control and Prevention and the 2022 LGBTQ Aging Needs Assessment.

Provider Information

Submitter Name(Required)

First Last

Preferred Method of Contact

Submitter Email Address(Required)

Email Address Confirm Email Address

Submitter Phone(Required)

Provider Name(Required)

Name

Please provide the name of your business/agency/practice.

Welcome Assessment

Please answer the following questions to the best of your ability. Not all questions may apply exactly to your setting.

1. Do your organization’s intake forms include diverse options for gender, gender identity, sexual orientation, relationships, and pronouns?

Yes

No

Don't Know

2. Do your organization’s board, volunteers, and staffing reflect the communities you serve?

Yes

No

Don't Know

3. Do you offer extended office hours or offer more flexible appointment times one or more days per week (e.g., offer some walk-in or same-day appointments)?

Yes

No

Don't Know

4. Do you use patient/client-tracking systems to determine whether a patient/client has dropped out of care and promptly follow up to reschedule missed appointments?

Yes

No

Don't Know

5. When warranted, do you encourage your HIV patients/clients to access substance use or mental health services?

Yes

No

Don't Know

6. Do you encourage your HIV patients/clients to identify friends and family who can help with encouragement and support and attend medical appointments with them?

Yes

No

Don't Know

7. Do you have practice-wide marketing (such as posters and brochures) and support (such as customer service training for patient-facing staff) that address the needs of HIV-positive individuals?

Yes

No

Don't Know

8. Do you advocate for medication adherence support (e.g. apps, psychoeducation) for HIV patients/clients?

Yes

No

Don't Know

9. Do you employ strategies for retention and re-engagement support for out-of-care patients/clients or those at risk of falling out of care (such as patients/clients who missed a care visit or are experiencing barriers to care engagement)?

Yes

No

Don't Know

10. Are you connected with local or state health departments or local community-based organizations that can provide additional HIV support services to your patients/clients?

Yes

No

Don't Know

Comments

This field is for validation purposes and should be left unchanged.

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Suite 1500
Minneapolis, MN 55415

Phone 612-341-2060

AIDSLine 612-373-2437

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