Maryland Latent Tuberculosis Infection (LTBI) Reporting Form: Fill out & sign online

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Maryland Latent Tuberculosis Infection (LTBI) Reporting Form with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the Maryland LTBI Reporting Form in our editor.
Begin by filling in the provider's name, affiliation, and telephone number at the top of the form. This information is crucial for identifying the reporting agency.
Indicate the LTBI case status by checking the appropriate box: Confirmed, Suspected TB Infection, or Not a case. If known, enter the LTBI case number.
Complete the demographic section with patient details including last name, first name, date of birth, sex at birth, address, and contact information. Ensure accuracy as this data is vital for tracking.
In the Reporting Information section, specify the name of the reporting agency and select reasons for testing. Check all applicable risk factors that apply to the patient.
Fill out Testing and Evaluation details including test dates and results. Be thorough in documenting any chest imaging results and final evaluation outcomes.
Lastly, complete the Treatment section by indicating whether treatment was offered and accepted. Document any reasons for not starting treatment if applicable.

Start using our platform today to easily fill out your Maryland LTBI Reporting Form online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Contact us

Does latent TB need to be reported?

Latent Tuberculosis Infection (LTBI) Tuberculosis (too ber cu LOW sis), or TB, is the common name for a germ called Mycobacterium tuberculosis. Persons with latent TB infection (LTBI) do not feel sick. They do not have any symptoms but can potentially develop active TB disease.

What is the full form of LTBI?

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.