This questionnaire is for use with confirmed and probable cases.
This questionnaire is in two parts:
- Part 1 (page 3 - 17) should preferably be completed by someone who has knowledge or experience of people who use drugs
- Part 2 (page 18 - 26) should be completed by someone who has access to the patient’s clinical records
Information in Part 1 should be obtained from a case or proxy - in the following preferred order
- The case (if alive) or
- If the case is deceased or otherwise unable to give a history, a proxy should be used in the ollowing order
- Someone who shared drugs with the case recently
- Close friend
- Family member
Please return completed questionnaires within 5 days of interview, preferably as soon as possible.