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Addiction treatment tb assessmentreferral form 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering the program and counselor details at the top of the form, including their phone number.
- Fill in the client’s name, referral date, birth date, address, sex, and race. Ensure all fields are completed accurately for proper identification.
- In Section I, answer the TB history questions. If any answers are 'Yes', you can skip to Section III. Otherwise, proceed to Section II.
- In Section II, assess TB risk by answering each question regarding HIV infection and drug history. If all answers are 'No', stop here; no referral is needed.
- If any answers in Section II are 'Yes', complete Section III with the TB clinic information and reason for referral.
- Finally, ensure that all comments and follow-up reports are filled out as necessary before submitting the form.
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| 2005 | 4.9 Satisfied (57 Votes) |
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Dec 8, 2023 Inquire about family members history of active/latent TB and prior treatments; Active disease should be treated aggressively. LatentRead more