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HIV and Enteropathy
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Create a Profile
Already an AAHIVM Member? (or do you already have a Profile?) Please login here.
If you do not have an AAHIVM login Profile, you may create one below by selecting the option to be displayed in our free and public online HIV care resource directory. An email confirmation will be sent which requires your reply to complete your Profile set up. Your Profile is free, but is required to become an AAHIVM Member or to apply to Credential. Active Membership is required for Member-only website features.
 User Information
AAHIVM will never publish your personal contact information. Only your professional details will be published in Referral Link.
[*] required fields
  Prefix:
* First Name:
  Middle Name:
* Last Name:
  Enter ALL degrees in your title:
If you currently hold an Academy certification, your AAHIVS, AAHIVE (non practicing) or AAHIVP (HIV Pharmacists) designation should appear last in your list of professional degrees. For example, "MD, FACP, AAHIVS". Your AAHIVM certification status can always be seen in the purple status box when logged in.

(Ctrl + Click to select multiple.)
* Provider Type:
  Specialty:
 


 
  Race/Ethnicity:
  Gender:
  Nickname:
* Home Address 1:
  Home Address 2:
  Home Address 3:
* Home City:
* Home State:
(Select “Other” for non-U.S. locations)
  AAHIVM Chapter:
  Home Country:
* Home Postal Code:
* Office Phone:
-- ext.:
  Home Phone:
--
  Fax: --
  Cell Phone:
--
  Appointment Phone: --
(This is the only phone number that will be published in Referral Link.)
  Personal Fax: --
* Personal Email:
(Your email is also your login username.)
  Company:
  Department:
  Position:
  Organization 1:
 
 Select Organization (If you work at a major facility, please search for your organization among those already listed in the Referral Link directory.)
  Organization 2:
 
* Please select your mailing address for AAHIVM correspondence:
   
* Please select your emailing address for AAHIVM correspondence:
   
  Office Hours:
  Admission Hospitals (if you don’t see patients, indicate ‘none’):
 
* Services that you offer HIV patients:
(Do not include services offered by other providers in your organization; please have those providers update or create their own individual Profile.)
 
Primary Medical Services
 



Specialty Care Services
 

Additional Clinical Services
 



Additional Clinical Services (cont’d)
 


Support Services
 





 
  Please select the payment types accepted in your practice:
 
*
Would you like to be listed in our online public directory, Referral Link?:
 
 
  Photo:
(Photo type should be GIF, JPG, JPEG or PNG file types, and size must be 150 X 150 pixels to avoid distortion. Photos must be professional in nature and are subject to AAHIVM approval.)
  Notes: