Get the free Tuberculosis Contact Investigation Form - doh wa

Tuberculosis Contact Investigation Form Submitted By: Date: DOH 343-059 March 2011 Case Name: (last) (first) (MI) Contact (also known as) Priority of exposed contact Investigation (please refer to

How to fill out tuberculosis contact investigation form

How to fill out a tuberculosis contact investigation form:

1. Start by gathering all the necessary information. This includes the patient's name, date of birth, contact information, and any known tuberculosis diagnosis or symptoms.
2. Next, provide details about the person who may have been exposed to tuberculosis. This includes their name, date of birth, contact information, and any relevant medical history or known risk factors.
3. Fill out the sections related to the potential exposure. This includes the date and location of the exposure, the duration of the contact, and any specific activities or circumstances that may have contributed to the exposure.
4. Provide details about any symptoms or signs of tuberculosis exhibited by the contact person. This can include information about a cough, fever, weight loss, or any other relevant symptoms.
5. If the contact person has undergone any medical evaluations, such as tuberculin skin testing or chest X-rays, make sure to provide the results and dates of these tests.
6. Lastly, sign and date the form to confirm its accuracy and completeness.

Who needs a tuberculosis contact investigation form:

1. Individuals who have been in close contact with someone diagnosed with tuberculosis may need to fill out a tuberculosis contact investigation form.
2. Healthcare professionals involved in the diagnosis and treatment of tuberculosis patients may also be required to complete this form for contact tracing purposes.
3. Public health officials and agencies tasked with monitoring and controlling the spread of tuberculosis may utilize this form to gather necessary information and conduct appropriate investigations.

For pdfFiller’s FAQs

What is tuberculosis contact investigation form?

The tuberculosis contact investigation form is a document used to track and investigate individuals who have come into contact with someone diagnosed with tuberculosis.

Who is required to file tuberculosis contact investigation form?

Healthcare providers, facilities, and public health departments are required to file tuberculosis contact investigation forms.

How to fill out tuberculosis contact investigation form?

The form should be filled out with accurate information about the contact, including their personal details and exposure to tuberculosis.

What is the purpose of tuberculosis contact investigation form?

The purpose of the form is to prevent the spread of tuberculosis by identifying and monitoring individuals who may have been exposed to the disease.

What information must be reported on tuberculosis contact investigation form?

The form should include details about the contact's name, contact information, exposure to tuberculosis, and any symptoms they may be experiencing.

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