Program Overview

Statistical Information

Forms

Resources for Patients

Resources for Providers

Links

Contact Us

TB Home

Forms

Some files on this site are in Adobe Acrobat (.pdf) format. You'll need the most current version of Adobe Acrobat Reader (Version 5.0) to view these files. Click here to test your browser to see if you have the Acrobat plug-in installed.

• Latent Tuberculosis Infection and Disease Reporting Form (.pdf)
• Request for Anti-Tuberculosis Medications (.pdf)
• Request for Anti-Tuberculosis Medications Additional Medications Form (.pdf)
• Request for Reimbursement for Provision of Directly Observed Therapy in Treatment of TB Disease (.pdf)
• Request for Tuberculin Purified Protein Derivative (PPD) (.pdf)
• State Issued PPD Usage Log (.pdf)
• Tuberculosis Clinic Patient Record (.pdf)
• Tuberculosis Contact Investigation Form (.pdf)
• Tuberculosis Medication Administration Record (.pdf)
• Tuberculosis Medication Monitoring Report (.pdf)
• Tuberculosis Skin Test High Risk Criteria Codes (.pdf)
• Tuberculosis Update Training Brochure (.pdf)