Forms Related to Bulletin #138
- Bulletin 138 Form 1 - HIV Testing and Informed Consent
- Bulletin 138 Form 2 - HIV Notification Letter - Release of Information
- Bulletin 138 Form 3 - Model HIV Notification Letter Negative
- Bulletin 138 Form 4 - Model HIV Notification Letter - Indeterminate
- Bulletin 138 Form 5 - Model HIV Notification Letter - Positive
Insurance Division Bulletin 138 (Revised)
HIV Testing Information & Consent Form
The purpose of this bulletin is to notify insurers that effective July 1, 2019, Title 8 V.S.A. 4724(20), regarding HIV testing requirements, was amended by Act No. 57 of the 2019 Legislative Session.
The forms for consent, disclosure, and notification of test results must be filed with and approved by the Commissioner prior to their use. The department has drafted revised model forms: HIV TESTING INFORMATION STATEMENT & CONSENT FORM (VT-Bulletin138-Form 1 (Rev. 09/19)) and Vermont Notification of Test Result Letters ( VT-Bulletin138-Form 2, 3, 4, 5 (Rev. 09/19)), for insurers to consider using. Use of these forms will result in an expedited approval.
Questions should be directed to:
Director of Rates and Forms
Vermont Department of Financial Regulation
Phone: (802) 828-4871
Dated at Montpelier, Vermont on this ______day of September, 2019.
Michael S. Pieciak, Commissioner