HIV Treatment Adherence Checklist
Patient Name
Date
Provider Name
Adherence Tasks
Take HIV medications at the scheduled times.
Take the full prescribed dose each time.
No missed doses since last check.
Medication refills obtained on time.
Follow dietary or food requirements with medications.
Managed any side effects effectively.
Kept scheduled clinic/medical appointments.
Used support resources if needed.
Barriers or Challenges Observed
Additional Notes / Next Steps