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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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BCG FAQ
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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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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.
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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.
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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.
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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.
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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.
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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.
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