TB Suspect Request for Hospital Discharge 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's information, including their name, date of birth, address, and contact numbers in the designated fields.
3. Fill out the submitting facility details along with the Medical Record Number (MRN) to ensure proper tracking.
4. In the Discharge/Transfer Plan section, specify the admission date and planned discharge/transfer date. Select where the patient will be discharged or transferred to from the options provided.
5. Indicate if there are children under 5 years, elderly individuals, or immunocompromised persons at the discharge address. Also, note any financial barriers to TB treatment.
6. Complete the Physician’s Diagnosis section by selecting symptoms and providing relevant test results. Ensure all necessary tests are documented accurately.
7. List medications prescribed for TB treatment along with their dosages and dates started/stopped. Provide a reason for discontinuation if applicable.
8. Finally, review all entries for accuracy before saving or sharing your completed form through our platform.

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