Get Tx Tb-400a 2020-2025

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.