Tuberculosis (TB) - Forms

Reporting Forms - Nevada TB Forms

• Latent TB Infection (LTBI) Confidential Report Form
• LTBI Treatment Flowsheet- LTBI Optional Companion Form
• Confidential Morbidity Report Form
• Interjurisdictional Tuberculosis Notification (IJN) & Follow up Forms
• Tuberculosis Medication Dispensing Form

Facility Risk Assessment Forms

• Healthcare Facility Risk Assessment Worksheet (Appendix B)
• Individual TB Risk Assessment Form

CDC Form - RVCT (Local Health Authorities)

• Report of a Verified Case of Tuberculosis, 2020 form

Transfer Notification Forms

• International TB Transfers - CDC Cure TB
• Interjursidictional Form (IJN)
• Interjurisdictional Forms for Transfer and Follow Up

Electronic Disease Notification System Forms

• TB Follow UP Worksheet
• EDN Interjurisdictional Transfer Protocol
• EDN Quick Help Guide