Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Forms:
Alaska State Public Health Laboratory TB PCR Testing Authorization Form
Alaska TB Program: Timeline for Case Management of Tuberculosis Treatment
Anchorage State Public Health Laboratory Request Form
Consent for Release of Medical Information
Contact Investigation Form – standard form (3 pages)
Contact Investigation Form – Instructions
DOT Calendar
DOT Aide Job Description (2 pages)
DOT Aide Memorandum of Agreement
DOT Aide Monthly Invoice for Payment
End of Treatment Letter and Summary (2 pages)
Infectious Disease Report Form
Interjurisdicational TB Notification
Interjurisdicational TB Notification Follow-up
Interjurisdicational TB Notification & Follow-up - Instructions (5 pages)
Liver Function Test Flowsheet
LTBI Treatment Completion Form and Instructions
PPD Order Form
Referral and Authorization for TB Screening / Follow-up Services
Sputum Collection Guidelines
TB Case Management Form
TB Case Management Information Request
TB/LTBI Prescription and Medication Request (2 pages)
ALASKA TUBERCULOSIS PROGRAM MANUAL FORMS 18.1
Revised November 2012