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Get the free Tuberculosis Case Report Form (with field names) v25/10/2012

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Page 1 of 5CASE REPORT FORMTuberculosisTuberculosisEpiSurv No. EpiSurvNumberDisease Name DiseaseName Tuberculosis disease new caseTuberculosis disease relapse or reactivation Tuberculosis infection
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How to fill out tuberculosis case report form

01
Obtain the tuberculosis case report form from the appropriate health authorities or healthcare provider.
02
Fill out all required personal information of the patient including name, age, sex, contact information, and address.
03
Provide detailed information about the medical history of the patient including past TB medication, treatment, and any other relevant health conditions.
04
Document the results of any diagnostic tests for TB including sputum tests, chest x-rays, and lab results.
05
Include information about the treatment plan for the patient such as medication regimen, follow-up appointments, and any other relevant instructions.
06
Make sure to sign and date the form as the healthcare provider completing the report.

Who needs tuberculosis case report form?

01
Healthcare providers
02
Public health officials
03
Research institutions
04
Non-governmental organizations (NGOs) involved in TB control programs
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Tuberculosis case report form is a document used to report information about individuals diagnosed with tuberculosis.
Healthcare providers and laboratories are required to file tuberculosis case report form.
Tuberculosis case report form should be filled out with the patient's personal information, diagnosis details, treatment information, and any other relevant data.
The purpose of tuberculosis case report form is to track and monitor tuberculosis cases for public health surveillance and control.
Information such as patient's demographic data, laboratory results, treatment regimen, and contact tracing details must be reported on tuberculosis case report form.
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Relevant keywords

2012 mantoux episurv episurvnumber addressmatchaccuracy streetname towncity geocodegeocode postcode bovis nz pcr clusterid induration dhb housenumber rflp miru mycobacterium rifampicin excl contnzname ltbi intraabdominal

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