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Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska

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How to use the TB/LTBI Stock TB Medication Request Form:<br />

Please submit this form to the AK TB <strong>Program</strong> via fax to 907-563-7868.<br />

General Information:<br />

Please enter the following: The name <strong>of</strong> your facility, the date <strong>of</strong> your request, the quantities/doses on hand, the<br />

quantity ordered, and the name <strong>of</strong> the person completing the form.<br />

Specific information:<br />

You must indicate the amount you have on-hand for items you are requesting.<br />

Do not wait until your stock is depleted to place an order.<br />

We ask that you try to limit your stock to a 1-month supply. In general, we ship to facilities monthly.<br />

Blank lines are available for special requests.<br />

The Bulk stock “max” quantities are indicated in bottles, and your request should reflect a number <strong>of</strong> bottles.<br />

The “container size” indicates the number <strong>of</strong> tablets per bottle or unit dose pack.<br />

The Starter Packs “max” quantities are indicated in doses, and your request should reflect a number <strong>of</strong> doses.<br />

The AK TB <strong>Program</strong> will review and approve all orders prior to forwarding to the Drug Room for processing.<br />

Call the Drug Room at 341-2207 with questions.<br />

Rev 10/11

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