Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska Alaska Tuberculosis Program Manual - Epidemiology - State of Alaska
Tuberculosis Treatment Contract Department of Health and Social Services DIVISION OF PUBLIC HEALTH Section of Epidemiology 3601 C Street, Suite 540 Anchorage, Alaska 99503 Main: 907.269.8000 Fax: 907.562.7802 I, __________________________________________, have been told and counseled by __________________________________________ that I have active tuberculosis (TB). The following has been explained to me: TB can be spread through the air to others. Without treatment, TB can cause severe illness, disability and death. TB treatment usually takes at least 6 months but may take 12 months or longer. I must take TB medications for my health and the health of others. This is so important that my TB medications will be provided by directly observed therapy (DOT). This means that a public health nurse (PHN), community health aide/practitioner (CHAP), or DOT aide will be assigned to deliver and watch me take my TB medications. I will be considered infectious until the Alaska TB Program gives me clearance. While infectious, I must isolate myself to avoid spreading TB to others. I need to stay at home, without visitors, unless approved by the Alaska TB Program. I will not visit the homes of others, churches, workplaces or other places where I will be in contact with others. If I must go to the store, doctor, or use a taxi, I will wear a mask as instructed. I agree to follow-up medical evaluations with my health care provider to make sure that my TB is getting cured and I am not having side effects from my TB medications. This includes keeping appointments, and submitting to blood, sputum and x-ray examinations. I agree to notify the PHN, DOT aide/health aide or doctor of any medication side effects that I may have as soon as they occur. I agree to assist the PHN and the Alaska TB Program to identify my contacts because they may be at risk for tuberculosis. I understand that I will not be identified by my PHN Case Manager during the contact investigation. I have had an opportunity to ask questions and have had my questions answered. Rev 11/12
The Alaska TB Program and my PHN Case Manager will do the following: Provide me with information about tuberculosis, how it is spread, how it is treated and what side effects I might have while taking TB medications. Provide all TB medications free of charge. Arrange for all TB medications to be given to me by a public health nurse (PHN), community health aide/practitioner (CHAP), or DOT aide. Work with me to find the most convenient time and place to provide directly observed therapy during my treatment. Arrange for my PHN, CHAP or DOT Aide to monitor and follow-up on any side effects to medications I may experience. Work with my health care provider to make sure that I receive and complete approved treatment for my TB. _______________________________ ________________ Client Signature Date _______________________________ ________________ PHN Case Manager Signature Date Rev 11/12
- Page 399 and 400: Anchorage Alaska State Public Healt
- Page 401 and 402: INDEX CASE INFORMATION Name: DOB: /
- Page 403 and 404: CONTACT Name: Tuberculosis Contact
- Page 405 and 406: Directly Observed Therapy (DOT) Cal
- Page 407 and 408: B. Documents patient care activitie
- Page 409 and 410: Alaska TB Program Section of Epidem
- Page 411 and 412: Treatment Summary for Active TB Nam
- Page 413 and 414: Interjurisdictional Tuberculosis No
- Page 415 and 416: ! !"#$%&'%()*(+#(,"-./0'1$%+'.,)()/
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- Page 419 and 420: ! ?"#51)09/02!H0/.!9:(78;7)37028!/'
- Page 421 and 422: Latent Tuberculosis Infection (LTBI
- Page 423 and 424: Alaska Tuberculosis Program 9210 Va
- Page 425 and 426: Instructions for Collecting Sputum
- Page 427 and 428: TB Case Management Information Requ
- Page 429 and 430: Table 1: First-line anti-tuberculos
- Page 431 and 432: Return the fax to the Drug Room (90
- Page 433 and 434: Stock Orders: A small supply of
- Page 435 and 436: TB/LTBI Medication Return Form Reas
- Page 437 and 438: TB/LTBI Stock Medication Request FA
- Page 439 and 440: TB Medication Dose Monitoring Regim
- Page 441 and 442: TB Medication Dose Monitoring Regim
- Page 443 and 444: ALASKA DEPARTMENT OF HEALTH AND SOC
- Page 445: Tuberculosis Discharge Planning Che
- Page 448 and 449: PART 2: 8. Have you ever been told
- Page 452 and 453: Statutes and Regulations Contents I
- Page 454 and 455: Regulations Infection Control 7 AAC
- Page 456 and 457: place of work is remote from patien
- Page 458 and 459: (2) the child or a person acting on
- Page 460 and 461: Glossary acid-fast bacilli (AFB): M
- Page 462 and 463: eaction size on a later test, which
- Page 464 and 465: disseminated TB: See miliary TB. dr
- Page 466 and 467: immunocompromised and immunosuppres
- Page 468 and 469: include medical history and TB symp
- Page 470 and 471: thousands to millions of copies of
- Page 472 and 473: secondary (TB) case: A new case of
- Page 474: eproducing TB organisms from respir
The <strong>Alaska</strong> TB <strong>Program</strong> and my PHN Case Manager will do the following:<br />
Provide me with information about tuberculosis, how it is spread, how it is treated and<br />
what side effects I might have while taking TB medications.<br />
Provide all TB medications free <strong>of</strong> charge.<br />
Arrange for all TB medications to be given to me by a public health nurse (PHN),<br />
community health aide/practitioner (CHAP), or DOT aide.<br />
Work with me to find the most convenient time and place to provide directly observed<br />
therapy during my treatment.<br />
Arrange for my PHN, CHAP or DOT Aide to monitor and follow-up on any side effects<br />
to medications I may experience.<br />
Work with my health care provider to make sure that I receive and complete approved<br />
treatment for my TB.<br />
_______________________________ ________________<br />
Client Signature Date<br />
_______________________________ ________________<br />
PHN Case Manager Signature Date<br />
Rev 11/12
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