CARE for AIDS Client Follow Up Form
Demographics
Name of Community/ Center *
Region
Name *
Your answer
Age *
Your answer
ID Number *
Your answer
Gender *
How many children do you have under the age of 18 years old? *
Did you have any babies during the course of the CARE for AIDS program?
If yes, what is the baby's HIV status?
Do you accept Jesus as your personal Lord and Savior?
OBSERVATION: Comments (if any) regarding client's answer to previous question:
Your answer
Do you regularly attend a local church?
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