Get Iowa Department Of Public Health Tuberculosis Control Program Patient Information Sheet For

Navigating the Iowa Department Of Public Health Tuberculosis Control Program Patient Information Sheet is vital for proper documentation of latent tuberculosis infection treatment. This guide provides step-by-step instructions to assist users in accurately completing the form online.

Follow the steps to successfully fill out the patient information sheet.

1. Click ‘Get Form’ button to access the form and open it in the editor.
2. Begin filling out the patient information section. Enter the last name, first name, and middle name in the designated fields. Provide personal details including gender, street address, city, county of residence, date of birth (in the format M/D/Y), zip code, and phone number (home or cell).
3. Move to the diagnostic information section. Enter the date of the Mantoux skin test and the results in millimeters, excluding erythema. For the IGRA test, choose one of the tests (QFT-GIT or T-SPOT), enter the date, and provide the results.
4. Fill in the chest X-ray details. Input the date of the chest X-ray and its results, marking whether pulmonary TB disease has been ruled out as yes or no, and provide the result classification (normal/abnormal, positive/negative). Indicate whether the diagnosis of LTBI is confirmed.
5. Complete the prescription information section. Specify the dosage of INH (300 mg) for a duration of either 6 or 9 months. Also, indicate the dosage of pyridoxine (vitamin B6) per day for the selected duration.
6. Enter the clinician information. This includes the clinician's name, clinic name, and contact information such as street address, city, phone number, and fax number. Select the appropriate option for where to send the medication.
7. Ensure that the checklist at the end of the form is completed. Verify that all necessary documents, including the patient information sheet, radiology report, and clinician signature, are attached. If the clinician did not sign the form, ensure a separate prescription is included.
8. Once all fields are filled out accurately, review the form for completeness. You can save changes, download a copy, print, or share the form as needed, ensuring all documentation meets submission requirements.

Complete your documents online today to ensure effective and timely treatment.