Addiction treatment tb assessmentreferral form 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the program and counselor details at the top of the form, including their phone number.
3. Fill in the client’s name, referral date, birth date, address, sex, and race. Ensure all fields are completed accurately for proper identification.
4. In Section I, answer the TB history questions. If any answers are 'Yes', you can skip to Section III. Otherwise, proceed to Section II.
5. 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.
6. If any answers in Section II are 'Yes', complete Section III with the TB clinic information and reason for referral.
7. Finally, ensure that all comments and follow-up reports are filled out as necessary before submitting the form.

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