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  • Paulo Behar

Prescription Form for Antiretrovirals in Brazil

Updated: Jun 8, 2023

Digital form for use in telemedicine

Text written for Health Professionals

In Brazil, antiretrovirals (ARV) are distributed free of charge to patients who require them. The prescription of ARV drugs is done through filling out a form from the Ministry of Health, called the Antiretroviral Medication Request Form (ARV). Different forms, depending on the clinical scenario for which the prescription is being made, can be found in the Medication Logistics Control System (SICLOM) / Forms. The link is The direct link for ARV prescription requests for adolescentes, pregnant women, and adults is

Mandatory Form

This form is required for the dispensing of ARVs to take place. Initially, there was only the use of the physical paper form. Later, the digital version emerged, which became more widely used during the COVID-19 pandemic, while still remaining mandatory.

The Form in Telemedicine

Durante a a pandemia de covid-19, no cuidado das pessoas vivendo com HIV/Aids (PVHIV) e em complementação aos Ofícios Circulares nº 8 (0014011726) e nº 12/2020/CGAHV/DCCI/SVS/MS (0014517283), o Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis (DCCI) recomendou:

During the COVID-19 pandemic, in the care of people living with HIV/AIDS (PLWHA) and in addition to Circular Letters No. 8 (0014011726) and No. 12/2020/CGAHV/DCCI/SVS/MS (0014517283), the Department of Chronic Diseases and Sexually Transmitted Infections (DCCI) recommended:

1. Regarding the use of telemedicine for the care of people living with HIV (PLHIV), regulated by Law No. 13,989 of April 15, 2020, as an instrument for maintaining care and prescribing and requesting tests:

a) The prescription of medications and the request for tests must be made according to the regulation, through the digital signing of documents, via the ICP-Brazil platform, with a digital certificate. The guidelines for obtaining the digital certificate and how to sign the documents related to the care of PLHIV can be found in Annex 1 (0015068843). The fillable PDF documents (ARV treatment form, PEP, PrEP, T CD4+ lymphocyte count requests, HIV viral load, HIV genotyping, and HLA-B\*5701 allele typing) are available on the page:

b) Cases of patients with complaints that cannot be assessed by teleconsultation, or that require a physical examination, or other clinical situations that require face-to-face consultations should be assessed in person.

c) Medication Dispensing Units (MDUs) should be instructed to accept the digital format of the ARV Request Form electronically signed by the prescriber, with a digital certificate, presented at the time of dispensing. In turn, it is recommended that doctors and/or patients send the form to the MDU's email or the person responsible for dispensing, for control purposes.

2. To ensure the continuation of treatment and reduce the flow of people in health services, the validity of active ARV Request Forms – Treatment, that is, those with a current form balance equal to or greater than 30 days, will be automatically renewed for an additional 90 days (in addition to the 90 days already extended by Circular Letter No. 08/2020/CGAHV/DCCI/SVS/MS). May 29, 2020 SEI/MS - 0015068737.

Reference: Brazil. Ministry of Health. Health Surveillance Secretariat. Department of Chronic Diseases and Sexually Transmitted Infections. General Coordination of HIV/AIDS and Viral Hepatitis Surveillance. CIRCULAR LETTER No. 13/2020/CGAHV/DCCI/SVS/MS. Brasília, May 28, 2020.

Electronic Signature eletrônica

As described above, the prescription of medications and the request for exams must be done according to regulations, through the digital signature of documents, via the ICP-Brazil platform, with a digital certificate. The Brazilian Public Key Infrastructure - ICP-Brazil is a hierarchical chain of trust that enables the issuance of digital certificates for the virtual identification of citizens. The steps for digitally signing the forms are:

1st step: Obtain the electronic signature through a digital certificate issued by the Brazilian Public Key Infrastructure (ICP-Brazil model A3, card or token). On the Federal Council of Medicine's website (, it is possible to consult special conditions for doctors to obtain the certificate through a technical cooperation agreement that the CFM established with three AC (Certifying Authorities) to offer the digital certificate of type PF A3.

2nd step: After obtaining the digital certificate, go to the page and look for the form (fillable PDF version) of the document you want.

3rd step: Fill out the document in question. For example, the ARV Dispensing Form - Treatment, with the patient's data and prescription, using the Adobe Acrobat Reader program. If your computer does not have this software installed, download it here:

4th step: After completing the prescription or filling out the document in question.

5th step: To verify the validity of the document, go to the website .

Appropriate use of editable PDF forms in SICLOM

In order to see the proper procedure for using SICLOM forms, view the self-explanatory image below:

Blog tips

1. Take advantage of this digital tool that greatly helps many patients, but for those who consult in person, this method doesn't add much.

2. However, for those patients with mobility difficulties, who live far away, or are monitored through telemedicine, it is very worthwhile to follow the guidelines of the Ministry of Health: "It is recommended that doctors and/or patients send the form to the UDM or the person responsible for dispensing, for control purposes." For example, the UDM email for the Sanitary Dermatology Clinic (ADS) in Porto Alegre is

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