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TB OUTCOME REPORTING FORM
CONFIDENTIAL
Page 1 of 2Patient Details
SurnameForenamePatient Patient address
Patient chart numberMRNTreating consultant name
If identified, please specify new diagnosis
Microbiological
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How to fill out tb outcome reporting form
How to fill out tb outcome reporting form
01
Obtain the TB outcome reporting form from your healthcare provider or the TB control program.
02
Fill out the patient's information, including name, age, sex, and address.
03
Indicate the type of TB diagnosis (e.g. pulmonary TB, extrapulmonary TB).
04
Enter the dates of TB treatment initiation and completion.
05
Record the outcome of the TB treatment (e.g. cured, completed treatment, treatment failure).
06
Sign and date the form, if required.
07
Submit the completed form to the appropriate healthcare provider or TB control program.
Who needs tb outcome reporting form?
01
Healthcare providers
02
TB control programs
03
Patients undergoing TB treatment
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What is tb outcome reporting form?
TB outcome reporting form is a document used to report the outcomes of tuberculosis cases, including treatment results and follow-up information.
Who is required to file tb outcome reporting form?
Healthcare providers, medical facilities, and public health agencies are required to file tb outcome reporting form.
How to fill out tb outcome reporting form?
TB outcome reporting form can be filled out by entering the necessary information such as patient details, treatment outcomes, and follow-up data in the designated fields.
What is the purpose of tb outcome reporting form?
The purpose of tb outcome reporting form is to monitor and track the progress of tuberculosis cases, ensure proper treatment, and prevent the spread of the disease.
What information must be reported on tb outcome reporting form?
The information reported on tb outcome reporting form includes patient demographics, treatment outcomes (cure, completion, failure, etc.), and follow-up data.
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