Nge SSN Medicaid # Name ID# (Last) (First) Street (Alias) (Middle) Apt# County City Facility/Care Provider Name Zip Code Patient s Tel.# Name of person completing this form Health Dept Military Hospital Initial Reporting Source Public Hospital Private Physician TDCJ A VA Hospital Other (Specify) Reported at Death Yes No Notice of Arrival of Alien with TB Class Country of Birth Date of U.S. Entry (if foreign born) Eligible for U.S. Citizenship/ Nationality at Birth? Pref.

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How to fill out the TX TB-400A online

The TX TB-400A form is essential for reporting tuberculosis cases and patient services. This guide will walk you through the process of filling out this form online, ensuring accuracy and completeness.

Follow the steps to successfully complete the TX TB-400A online.

  1. Click ‘Get Form’ button to obtain the TX TB-400A form and open it in the editor.
  2. Begin by entering the patient’s name, including their last name, first name, and middle initial. Ensure that you also include any aliases in the designated field.
  3. Fill in the patient's date of birth (DOB) and Social Security Number (SSN) in the respective fields. Provide the Medicaid number if applicable.
  4. Enter the patient’s address, including the street, apartment number, city, county, and zip code. Additionally, provide the patient's telephone number.
  5. Complete the section regarding the health department or facility reporting the case. Indicate the name of the facility or care provider.
  6. Indicate the initial reporting source, selecting from options like public hospital, private physician, or military hospital.
  7. Respond to the questions regarding the patient's immigration status, whether they were reported out of state or country, and if they were a resident of a correctional facility at the time of diagnosis.
  8. Provide information on the patient's occupation within the past two years, checking all relevant options.
  9. Indicate the patient's race and ethnicity by checking all applicable boxes.
  10. Fill in the medical risk factors associated with the patient. Check all that apply.
  11. Document the patient’s HIV test results and any previous tuberculosis testing history in the relevant sections.
  12. Complete the medication section, noting any prescribed treatments along with the dosages.
  13. Before submitting, review all entered information for accuracy and completeness. Ensure you have signed and dated the form.
  14. Finally, save the changes, and choose to download, print, or share the completed form as needed.

Take the next step in ensuring public health by completing the TX TB-400A online today.

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Is TB testing required in Texas?

In general, Texas Department of State Health Services does not recommend that low risk individuals be tested for tuberculosis. If a test is needed or recommended, the general public may ask their primary care provider, local clinics, or pharmacies, among other sites.

The Texas Department of State Health Services (DSHS) has been restructured to sharpen our focus on public health. Our job is to promote and protect the health of people, and the communities where they live, learn, work, worship, and play.

It is required by the state of Texas that individuals deemed cases of Tuberculosis disease must be reported within one business day to the local health authority. Reporting patients with Latent Tuberculosis infection to the local health authority is also required and must be done within one business week.

If you're diagnosed with pulmonary TB, you'll be contagious for about 2 to 3 weeks into your course of treatment. You will not usually need to be isolated during this time, but it's important to take some basic precautions to stop the infection spreading to your family and friends.

(v) Employees with a history of negative skin tests who are close contacts to a known or suspected case of TB shall be skin tested after exposure. If the test is still negative, they shall be retested 90 days after break in contact with the known or suspected case of TB occurs.

Get in Touch With DSHS By phone: 1-888-963-7111. Online at the DSHS website.

Tuberculin skin test conversion was defined as the change of tuberculin skin test from negative (<10 mm) to positive (≥10 mm) after 48 –72 h of inoculation.

If you have been diagnosed with TB you may be worried that you will have to take time off work and that you will lose money, or even your job. TB can be a serious illness, but if you are well enough to work, and are not infectious, then your employer cannot force you to stay at home.

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