Get Interjurisdictional Tb Notification Form

Completing the Interjurisdictional TB Notification Form online is a straightforward process that ensures accurate reporting and follow-up regarding tuberculosis cases. This guide will provide you with clear, step-by-step instructions to successfully navigate each section of the form.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to access the form and open it in the designated editor.
2. Fill in the 'Date Notification Received' section with the appropriate date using the format ____/____/____.
3. Enter the details of the person responsible for follow-up in the 'Return follow-up form to' section, including their 'Name,' 'Fax number,' and 'Address.' Ensure that you complete the 'City,' 'State,' and 'Zip Code' fields.
4. Provide the 'Phone number' for the person mentioned in the previous step.
5. In the 'Patient Name' section, fill out the 'Date of Birth' with the corresponding details along with 'Last,' 'First,' and 'Middle Initial' (M.I.) fields.
6. Specify the patient's 'Sex' by selecting either 'Male' or 'Female.'
7. In the 'Case' section, indicate the reason for therapy stoppage and provide the outcome date, formatted as ____/____/____.
8. Complete the 'Send F/U2 to reporting jurisdiction RVCT#' field with the appropriate reporting jurisdiction number.
9. For the follow-up status, indicate if the patient was 'Located,' 'Not Located,' 'Lost,' 'Died,' or if they were 'Uncooperative or refused' follow-up.
10. Specify the evaluation status in the appropriate section: 'Class II,' 'Class III,' 'Class IV,' or 'No infection.' Provide further details if treatment was started, continuing, or completed.
11. In the comments section, add any relevant information that could assist in the follow-up process.
12. Complete the 'Person completing form' and the 'Date completed' fields with the relevant details once the form is filled out.
13. Finally, review the completed form for accuracy, and then choose to save changes, download, print, or share the form as needed.

Complete your Interjurisdictional TB Notification Form online today for efficient and accurate documentation.