Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the form and open it in your preferred editor.
2. Begin by filling out the program information, including the name of the counselor and their phone number, if applicable.
3. Next, enter the client's details: their name, referral date, birth date, and address. It's important to ensure all information is accurate to avoid any delays.
4. Indicate the sex of the client by selecting the appropriate option: Male (M) or Female (F).
5. Fill in the race of the client in the designated field, as this information is often required for demographic purposes.
6. In Section I, provide information regarding the TB history. Answer each question regarding previous tuberculosis episodes, positive skin tests, or preventive therapy, marking 'Yes', 'No', or 'Unknown' as applicable.
7. If any of the answers in Section I are affirmative, stop filling out the form here as a TB skin test is not needed. Otherwise, proceed to Section II.
8. In Section II, assess the TB risk factors and indicate responses for each question. If the answer is 'No' to all items, referral is not needed; otherwise, continue to Section III.
9. In Section III, provide the name and contact details of the TB clinic, along with the appointment date. Clearly state the reason for the referral, selecting from the provided options, and include any additional comments necessary.
10. Finally, if you are responsible for follow-up documentation, complete Section IV by inputting results from the TB clinic, including any appointments or treatments initiated.
11. Review the entire form for completeness and accuracy before saving changes. Users can download, print, or share the form as needed after finalizing it.

Take action now by completing the Addiction Treatment TB Assessment Referral Form online to facilitate essential treatment and support.