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HIV Infection Functional Assessment Questionnaire (Version 4)

Published: August 9, 2026Updated: August 16, 2026

This questionnaire evaluates how HIV infection impacts your daily life, physical health, and quality of care. It helps your healthcare team understand your experiences and tailor support to your needs.

Quick summary

["Assesses functional impact of HIV to guide personalized treatment and support planning."]

Medically reviewed by WellAlly Editorial TeamLast reviewed August 16, 2026Editorial policy

Key facts at a glance

LOINC
71133-3
Short code
FUNCTIONALASSESSMENTOFHIVINFECTIONQUESTIONNAIREVERSION4
Synonyms
—
Category
chemistry
Sample
serum
Container
Red-top tube (SST)
Units
N/A
Fasting
false
Population
adult
Sex
all
Age range
18–65 years
Method
facit
CPT
86701
Specimen volume
5 mL
Stability
Room temperature: 4h, Refrigerated: 24h, Frozen: 7d
Hemolysis max
500
Lipemia max
1000
Icterus max
500
TAT
4–24 hours
Order
routine

What Is This Test For?

This is not a blood or lab test but a self-reported survey designed to measure how HIV affects your daily activities, energy levels, and overall well-being. It helps healthcare providers assess functional limitations and identify areas where support or adjustments might be needed in your treatment plan.

How Is This Questionnaire Administered?

You will complete this questionnaire online or by paper, answering questions about your physical, emotional, and social functioning related to HIV. Responses are confidential and used solely to improve your care.

Why Is This Important?

Your answers help healthcare teams track how HIV impacts your life over time. This information can guide decisions about treatment adjustments, support services, or lifestyle recommendations to improve your health and well-being.

What Does This Questionnaire Cover?

The questionnaire includes questions about your ability to perform daily tasks (e.g., work, self-care), emotional distress, pain levels, and satisfaction with your healthcare. It also assesses how well your treatment is working and any barriers you face.

Clinical interpretation

How abnormal results are interpreted and what conditions they suggest.

◆Associated findings1

Short name

HIV Assessment Questionnaire (V4)

Frequently asked questions

Does this questionnaire replace lab tests?
No, this questionnaire is a complementary tool that provides patient-reported insights into how HIV affects your daily life. It works alongside lab tests, physical exams, and clinical evaluations to create a full picture of your health.
How often should I complete this questionnaire?
Your healthcare provider will determine the frequency based on your needs. Typically, it may be completed at routine visits or as recommended by your care team, often every few months.
Will my answers be kept private?
Yes, all responses are confidential and protected under health privacy laws. Only your healthcare team with your permission will review your answers to improve care.
  1. 1
    MedlinePlus — Laboratory TestsSource
  2. 2
    Lab Tests OnlineSource
  3. 3
    Mayo Clinic — Tests & ProceduresSource

Click any link to access the full source. PubMed Central (PMC) links provide free full-text access.

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment.

Medical Disclaimer

This content is for general informational and educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare provider with any questions you have about a medical condition, and never disregard professional medical advice or delay seeking it because of something you read here.

If you think you may have a medical emergency, call your local emergency number or go to the nearest emergency department immediately.

Medically reviewed by WellAlly Editorial Team Last reviewed August 16, 2026. · Read our editorial policy