Report of Case and Patient Services Date form sent to HSR PHR 2026

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4.9 out of 5

55 votes

The document is a report form for case and patient services related to tuberculosis (TB) management. It includes sections for patient identification, reporting sources, medical history, risk factors, treatment details, and closure information. The form captures essential data such as personal demographics, health status, TB exposure history, and treatment regimens to facilitate public health reporting and monitoring of TB cases.

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How to use or fill out Report of Case and Patient Services Date form sent to HSR PHR

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Click ‘Get Form’ to open it in the editor.
Begin by entering the 'Date reported to health department' and 'Date form sent to PHR' at the top of the form. This establishes a timeline for your report.
Fill in the patient's personal information, including their name, Social Security Number (SSN), Medicaid number, address, and contact details. Ensure accuracy as this data is crucial for identification.
Indicate the initial reporting source by selecting from options such as Public Hospital or Private Physician. This helps track where the case originated.
Complete sections regarding patient demographics, including race, ethnicity, occupation, and medical risks. Check all applicable boxes to provide comprehensive information.
If applicable, fill out sections related to TB testing results and treatment history. Document any relevant dates and outcomes clearly.
Finally, review all entries for accuracy before signing off on the form. Use our platform's features to save or print your completed document as needed.

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Versions	Form popularity	Fillable & printable
2020	4.9 Satisfied (55 Votes)
2018	4.5 Satisfied (60 Votes)
2003	4 Satisfied (42 Votes)

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Do you have to disclose latent TB?

Reporting cases of latent TB infection to CDC is optional.

Is latent TB reportable in Texas?

(1) All occurrences of latent TB infection shall be reported no later than one week after diagnosis to the local health authority or a Texas Department of Health regional office.

Is latent TB reportable?

*Note routine reporting of Latent TB Infection is not required.

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Do you have to report TB to the CDC?

Tuberculosis (TB) disease is a nationally notifiable disease, and reporting is mandated in all U.S. states.

Does latent TB need to be reported in Texas?

(b) Latent TB infection. (1) All occurrences of latent TB infection shall be reported no later than one week after diagnosis to the local health authority or a Texas Department of Health regional office.

What is the protocol for latent TB?

Treatment regimens for latent TB infection (LTBI) use (INH), rifapentine (RPT), or rifampin (RIF). CDC and the National Tuberculosis Controllers Association preferentially recommend short-course, rifamycin-based, 3- or 4-month latent TB infection treatment regimens over 6- or 9-month monotherapy.

Report of Case and Patient Services Date form sent to HSR PHR 2026

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How to use or fill out Report of Case and Patient Services Date form sent to HSR PHR