Maryland Latent Tuberculosis Infection (LTBI) Reporting Form 2026

1. Click ‘Get Form’ to open the Maryland LTBI Reporting Form in our editor.
2. 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.
3. 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.
4. 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.
5. 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.
6. Fill out Testing and Evaluation details including test dates and results. Be thorough in documenting any chest imaging results and final evaluation outcomes.
7. 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!