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DEPARTMENT OF HEALTH SERVICES Division of Public Health F00905 (05/2016)TUBERCULOSIS INFECTION INITIAL REQUEST FOR MEDICATION Fields marked with an asterisk (*) are required. Please complete patient
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01
Obtain the necessary forms for tuberculosis infection testing from your healthcare provider.
02
Fill in your personal information, including name, date of birth, and contact details.
03
Provide your medical history, particularly any previous tuberculosis infections or treatments.
04
Answer questions related to your current health status and any symptoms you may be experiencing.
05
Include information about any risk factors, such as travel to areas with high tuberculosis rates or close contact with infected individuals.
06
Review the completed form for accuracy and completeness.
07
Submit the form as directed, either online, via mail, or in person at your healthcare facility.

Who needs tuberculosis infection - initial?

01
Individuals who have been in close contact with someone diagnosed with tuberculosis.
02
People exhibiting symptoms of tuberculosis, such as prolonged cough, fever, or weight loss.
03
Those with a compromised immune system, including individuals with HIV/AIDS or other immunosuppressive conditions.
04
Travelers returning from areas with high rates of tuberculosis.
05
Healthcare workers who may be exposed to tuberculosis in their profession.
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Tuberculosis infection - initial refers to the first stage of exposure to the tuberculosis bacterium, where an individual may test positive for the infection but not show active symptoms of the disease.
Individuals who have tested positive for tuberculosis infection, healthcare providers, and certain institutions like schools or workplaces that perform health screenings may be required to file a tuberculosis infection - initial report.
To fill out the tuberculosis infection - initial form, provide personal information, details of the test conducted, results, and any relevant health history as requested in the form’s sections.
The purpose of tuberculosis infection - initial reporting is to monitor and control the spread of tuberculosis, ensure timely treatment, and maintain public health safety.
The report should include the individual's name, date of birth, contact information, test results, date of testing, and any associated health history or symptoms.
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