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  • Latent Tb Infection Report

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Berculosis Control Program 410 Capitol Avenue, MS #11TUB P.O. Box 340308 Hartford, CT 06134-0308 PATIENT'S NAME: Voice: (860) 509-7722 (LAST) Fax:: (860) 509-7743 (FIRST) SEX: DATE OF BIRTH: M CITY: STREET ADDRESS: SSN: CONTACT TO KNOWN CASE? NO RACE: YES STATE: IF YES, NAME SOURCE CASE: AMERICAN INDIAN/ALASKAN NATIVE ASIAN: SPECIFY WHITE DD YYYY HOME TELEPHONE: HISTORY OF BCG VACCINE AND DATE? YES NO MM YYYY UNKNOWN ETHNIC ORIGIN: NATIVE HAWAI.

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A public health authority can disclose personal information if there is an overriding public health need. Patient authorization is NOT needed for passive case reporting. Passive case reporting is the required reporting of suspected or confirmed TB cases to a public health authority.

Diagnosis of latent tuberculosis infection is based on the detection of an immune response to Mycobacterium tuberculosis antigens using either the tuberculin skin test or -γ release assays. Current treatment requires the use of antibiotics for at least 3 months.

YES. Submission of the GOTCH form is required any time a patient with confirmed or suspected TB is discharged or transferred from a health care or correctional facility, including when patients being treated for TB are readmitted to the hospital.

Reporting to the local health department for TB infection is now required once TB disease has been ruled out. For applicants who are diagnosed with LTBI, civil surgeons must: Inform such applicants that their LTBI diagnosis has been reported to the local health department.

Latent Tuberculosis Infection (LTBI): Latent Tuberculosis Infection shall be reported to the local health authority or the Department of Health within three (3) calendar days of first knowledge or suspicion.

TB is a notifiable disease, meaning that clinicians have a statutory duty to notify local authorities or a local Public Health England centre of suspected cases, and efforts have been made to strengthen services and ensure clear lines of accountability and responsibility.

Any patients with confirmed or suspected active TB disease are required by law to be reported within 1 working day of identification to the TB Control Section. This includes any patient that has started empiric multi-drug therapy for active pulmonary/extra-pulmonary TB.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232