Tuberculosis Forms

Brochures (DOH)

See Educational Materials and Training Opportunities sections of TB website for pdf files of brochures on  TB Skin Test & INH

Forms (DOH)

Current forms used in County Health Department TB clinics
Note: Forms are available from the DOH warehouse in Tallahassee

Forms (CDC)

2003-RVCT-page 1 (pdf 87.77 kb)    
2003-RVCT-page 2 (pdf 68.70 kb)
Follow-up 1 (pdf 155.57 kb)
Follow-up 2  (pdf 213.81 kb)
ARPE-contacts (pdf 226.81 kb)
ARPE-LTBI (pdf 353.87 kb)

Using HCMS to generate reports Instructions:
Contact reports  (doc 75.00 kb)
Targeted Testing & Treating LTBI reports (doc 78.00 kb)

Inter-jurisdictional Notification (ICCR)

(New CDC forms)

Initial TB Notification Form-fill in style (doc 76.50 kb)

TB Notification Follow-up Form-fill in style (doc 36.50 kb)

Protocol/Instructions (doc 25.00 kb)

CDC Link - International Notification information

A G Holley State TB Hospital Admission Policy and Forms

See  AGH admission guideline (#14) in guidelines section

Request for Admission Form-Part 1 (.xls 188.50 kb)
Request for Admission Form-Part 2 (.xls 18.50 kb)

Forms (Letter templates)

Provider Diagnosis (pdf 37.98 kb)

LTBI:
2005 Distribution suggestions (doc 48.00 kb)
 

School Letters:
General  Letter to Parents (doc 23.00 kb)
Close Contact (doc 19.00 kb)

Forms(Quality Improvement)

Report of Tuberculosis Transmission (pdf 57.61 kb)

(HQ assistance or unusual case)

Education checklist (pdf 61.33 kb)

Forms Incentives/ Enablers)

Incentive Request (pdf 13.53 kb)

Enabler Request (pdf 8.32 kb)

Voucher Worksheet (pdf 18.19 kb)

Forms (Correctional)

TB Case Reporting (doc 63.00 kb)

Forms (Record Abstraction)

TB Cluster Investigation Form  (pdf 23.94 kb)

Forms (Retention Schedule)

DOH TB Form Retention Schedule  (pdf 26.0 kb)