HIV Clinical Trial Pre-Screening Checklist
Participant Information
Full Name
Date of Birth
Contact Number
Eligibility Checklist
Confirmed HIV diagnosis
Age within trial requirements
No history of non-adherence to HIV treatment
No current participation in other clinical trials
No pregnancy or breastfeeding (if applicable)
No significant comorbid conditions
Medical History
Relevant Medical History
Current Medications
List Current Medications
Comments / Notes