---
title: Chronic Parvovirus B19 Infection Screening Form for Immunocompromised Patients | Paperform
description: Professional healthcare screening form for chronic parvovirus B19 infection in immunocompromised patients with anemia assessment, PCR testing criteria, IVIG therapy evaluation, and infectious disease consultation.
url: "https://paperform.co/templates/chronic-parvovirus-b19-infection-screening-assessment-form"
type: static
generatedAt: "2026-03-28T00:43:19.208Z"
---

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### Comprehensive Parvovirus B19 Screening for Immunocompromised Patients

Chronic parvovirus B19 (PVB19) infection represents a significant diagnostic challenge in immunocompromised populations, particularly those presenting with persistent or unexplained anemia. This **Chronic Parvovirus B19 Infection Screening & Assessment Form** provides healthcare facilities, infectious disease specialists, and hematology departments with a structured, clinical-grade tool for evaluating at-risk patients and determining appropriate diagnostic and therapeutic pathways.

#### Why Specialized PVB19 Screening Matters

Parvovirus B19 causes transient illness in immunocompetent individuals, but in immunocompromised patients—including those with HIV/AIDS, organ transplants, hematologic malignancies, or receiving immunosuppressive therapies—the virus can establish chronic infection. This leads to persistent viremia and pure red cell aplasia, manifesting as severe, treatment-resistant anemia that significantly impacts quality of life and clinical outcomes.

Early identification of chronic PVB19 infection is crucial because:

 - Standard serologic testing (IgG/IgM) may be unreliable in immunocompromised hosts
 - PCR-based viral DNA detection provides definitive diagnosis
 - Intravenous immunoglobulin (IVIG) therapy can be curative when appropriately indicated
 - Delayed diagnosis leads to ongoing transfusion dependence and complications

#### Streamlining Complex Clinical Assessments with Paperform

This template transforms a complex multi-system evaluation into an organized, actionable workflow. Built with Paperform's healthcare-grade platform (SOC 2 Type II compliant), the form guides clinicians through:

**Patient Demographics & Clinical Context**
Capturing essential identifying information, immunocompromising conditions, and referring provider details to ensure continuity of care.

**Detailed Anemia Assessment**
Comprehensive evaluation of anemia severity, transfusion requirements, reticulocyte counts, and temporal progression—critical factors for distinguishing chronic PVB19 infection from other causes of cytopenias.

**Immunocompromised Status Documentation**
Systematic review of underlying conditions including HIV status, transplant history, malignancies, and immunosuppressive medications that predispose to chronic viral infection.

**PCR Testing Criteria & Laboratory Coordination**
Conditional logic determines PCR testing appropriateness based on clinical presentation, with automated collection of specimen details and laboratory preferences.

**IVIG Therapy Eligibility Screening**
Evidence-based assessment against established criteria for intravenous immunoglobulin therapy, including consideration of contraindications and prior treatment response.

**Infectious Disease Consultation Workflow**
Intelligent routing for specialist referral when complex cases require expert input, with urgency categorization and detailed clinical summary generation.

#### Ideal for Multiple Healthcare Settings

This form template serves:

 - **Infectious Disease Departments** conducting specialized diagnostic workups for unexplained cytopenias in immunocompromised populations
 - **Hematology & Oncology Practices** evaluating persistent anemia in patients with malignancies or post-transplant complications
 - **HIV Care Centers** screening for opportunistic infections contributing to treatment-resistant anemia
 - **Transplant Programs** monitoring solid organ and bone marrow transplant recipients for viral complications
 - **Hospital Medicine Services** coordinating diagnostic pathways for complex inpatients with multifactorial anemia

#### Enhancing Clinical Workflow with Automation

While this form provides immediate value for structured data collection, healthcare organizations can dramatically improve operational efficiency by connecting it to broader clinical workflows:

**Stepper Workflow Automation**
Use [Stepper](https://stepper.io) to automate downstream processes after form submission:

 - Automatically create laboratory orders in LIMS systems when PCR testing is indicated
 - Trigger specialist consultation requests directly into scheduling systems
 - Send conditional notifications to infectious disease teams for urgent cases
 - Update electronic health records with structured screening data
 - Generate pre-authorization requests for IVIG therapy when criteria are met
 - Route cases to pharmacy for IVIG protocol preparation

**Integration with Healthcare Systems**
Paperform's native integrations and webhook capabilities allow seamless connection to:

 - Electronic Health Records (EHR) systems for bi-directional data flow
 - Laboratory information systems for test ordering and results retrieval
 - Care coordination platforms for multi-disciplinary case management
 - Secure messaging systems for HIPAA-compliant provider communication

#### Professional, Secure Healthcare Forms

Built on Paperform's trusted platform used by over 500,000 teams worldwide, this template incorporates:

 - **SOC 2 Type II compliance** ensuring appropriate security controls for sensitive health information
 - **Conditional logic** that adapts the form based on patient responses, reducing cognitive load
 - **Custom validation** preventing incomplete or inconsistent clinical data
 - **Professional medical design** that inspires confidence from both clinicians and patients
 - **Multi-device accessibility** allowing form completion on workstations, tablets, or mobile devices

#### Evidence-Based Clinical Approach

This screening form reflects current best practices in infectious disease and hematology, incorporating:

 - WHO classification criteria for anemia severity
 - CDC guidelines for parvovirus B19 diagnosis in immunocompromised hosts
 - IDSA recommendations for IVIG therapy in chronic viral infections
 - Standard reticulocyte indices and bone marrow evaluation criteria

#### Getting Started

Healthcare organizations can implement this template immediately and customize it to align with institutional protocols, laboratory preferences, and referral pathways. The intuitive doc-style editor makes it simple for clinical administrators to adjust terminology, add institution-specific questions, or modify workflow routing—no technical expertise required.

For departments handling significant volumes of complex infectious disease cases, Paperform's Agency+ and Enterprise tiers provide advanced features including SSO integration, role-based access controls, and dedicated account management to support large-scale clinical operations.

By standardizing the approach to chronic parvovirus B19 screening, healthcare facilities can improve diagnostic accuracy, reduce time to appropriate therapy, and ultimately deliver better outcomes for vulnerable immunocompromised patients facing this challenging infectious complication.
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