TB forms for local public health agencies

Case forms

• Tuberculosis surveillance and case-management report (TB-18).
• Report a verified case of tuberculosis (RVCT).
• Chest X-ray confirmation form.
• TB contact investigation record.
• TB Treatment Completion Form.
• TB Testing and Treatment Record (Blue Card).

Screening forms

• Colorado Adult Tuberculosis Risk Assessment Form.
  • Colorado Adult Tuberculosis Risk Assessment User Guide.
• Colorado Pediatric Risk Assessment​
  • ​Colorado Pediatric Risk Assessment User Guide

Order forms

• TB skin testingsupplies.
• Medications.

Transfer forms

Interjurisdictional notification forms must be submitted directly to the CDPHE TB Program.

• Interjurisdictional notification form.
• Interjurisdictional notification follow-up form.
• Interjurisdictional notification form instructions.

Lab forms and instructions

• HIV/TB testing guidance.
• Sputum collection kit and instructions.

• Directly Observed Therapy Consent Form | Spanish

English

• TB isolation order.
• Termination of TB isolation order.
• TB patient treatment contract.
• Letter ordering treatment for active TB.
• Patient warning letter for refusing treatment of active TB.
• Warning letter for TB contact.

Spanish

• TB isolation order.
• Termination of TB isolation order.
• TB patient treatment contract.
• Letter ordering treatment for active TB.
• Patient warning letter for refusing treatment of active TB.
• Warning letter for TB contact.

Class BTB forms

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