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HIV Epidemiology Unit

   
AIDS/HIV Statistics Request Form * Required Fields
Many of the requested AIDS statistics for Los Angeles County and the Service Planning Areas (SPA), cities, and Health Districts (HD) within the county are available in the Advanced HIV Disease (AIDS) Surveillance Summary. Please review the summary report before completing a data request. (This publication is available for download at http://www.publichealth.lacounty.gov/hiv/index.htm in the REPORT section or can be mailed to you upon request via phone: 213-351-8516)
 
Please Note: Since HIV infection only became reportable in July of 2002, non-AIDS HIV data will not be available until such data are more complete and accurate; therefore requests for information on persons with HIV who do not have AIDS cannot be processed at this time. If the information that you require is not included in the summary report, please submit the following form either online or via fax. Please allow ten working days for completion.

Requestor Contact Information
* First Name:
* Last Name:
Job Title:
* Organization:
* Address:
* City:
* State:
* Zip Code:
* Telephone:
Extension:
Fax:
* Email Address:
* Desired Completion Date: MM/DD/YYYY
 
Detailed description of the request: When applicable, please indicate clearly (1) the time period(s) of interest, (2) the disease measurement(s) of interest-such as incidence or prevalence, cases by year of report or by year of diagnosis-(3) the geographical area(s) of interest, (4) the population of interest, (5) the demographic or risk variables for table breakdown, specify if you want cross tables. Note: To keep individual's information confidential, any data cells with less than 5 cases will simply be denoted as '<5'.
 
1.    * Time period(s): (check all that apply)
             All years (cumulative)
             Aggregated years: from to
             Individual years:
 
2.    * Disease Measurement: (check all that apply)
             Incident AIDS cases (cases occurring by year)
             Number of cases by year of diagnosis
             Number of cases by year of report
             Prevalent AIDS cases (that is, persons living with AIDS)
             Other measurements: (please specify)
                   
3.    * Geographic area(s): (check all that apply)
        To make multiple selections, hold the CNTL key and click on selection with your mouse
             Los Angeles County
             Service Planning Area
                   (SPA):
             Health District (HD):
             Area defined by census tract: (please specify)
                   
             Area defined by Zip Code: (please specify)
                   
4.     Population of interest: (specify as applicable: age group, gender, race,
        mode of exposure, or other demographic/health-related information.)
        
5.     Demographics/risks: (when applicable, specify desired breakdown
         by gender, race/ethnicity, mode of HIV exposure, or specific age group.)
        
6.     Other type of request or extra information needed:
        
 
    * How will these data be used?
             Journal Article/Letter              General Information
             Newspaper/Newsletter              Grant Application
             Presentation/Education              Program Evaluation
             Advocacy
             Other: (please specify)
    * How will you like the data to be transmitted?
             Mail
             Fax
             Email with attachment (select one)             
                   EXCEL table
                   Microsoft WORD file
                   PDF file
             Other: (Please specify)
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