DPH: Tuberculosis Forms

Tuberculosis Forms

 
 
Reporting of Suspect or Confirmed Tuberculosis (TB) Disease:
 
 
Surveillance Report Form, TB-86 form (2 pages) for initial TB disease reporting:
For all subsequent reporting on TB disease/suspect cases use the Tuberculosis Therapy and Follow-up Care Report Form, TB-32:
Tuberculosis Patient Discharge Plan:
This form should be completed by the hospital or outpatient health care provider for the continuation of care of those patients with TB disease.  This form must be sent to the local health department where the patient resides for approval.
 
         TB Patient Discharge Plan
 
Reporting of Latent TB Infection or TB/HIV Co-infection:
 
Latent Tuberculosis Infection (LTBI) Report Form for initial reporting of TB infection or TB/HIV co-infection:
For all subsequent reporting on LTBI use the Tuberculosis Therapy and Follow-up Care Report Form, TB-32:
Contact Investigation Forms
Active Cases:
Source Case Investigation Forms - Latent Infection in Children under 6 yrs of age:




Content Last Modified on 2/27/2014 11:24:45 AM