Tuberculosis Control Program Forms
TB Treatment and Follow-up Care Report Form (and instructions)
For all subsequent reporting on TB disease/suspect cases and LTBI.
This form should be completed by the hospital or outpatient health care provider for the continuation of care of those patients with TB disease. This form must be sent to the local health department where the patient resides for approval.
Contact Investigation Worksheet and Instructions
For reporting persons who are contacts to a TB patient with active disease during the established infectious period.
Connecticut TB Risk Assessment and User Guide
An assessment tool and guide which may be used to identify asymptomatic adults and children for latent TB infection testing.
TB Billing Forms
State Public Health Laboratory Forms/Reports (selected)
- Clinical Test Requisition form (OL-9B rev. 5/21/2021)
- Nucleic Acid Amplification (NAA)-Mycobacterium tuberculosis Test Requisition Form (4/18/2018)
- AFB Clinical Specimen Testing (Mycobacteria Smear and Culture) (rev. 6/9/2017)
- AFB Referred Culture (Mycobacteria for ID) Test (rev.6/9/2017)
- QuantiFERON® -TB Gold Plus (QFT Plus) Test (rev. 9/1/2018)
- Scientific Support Services
- Mycobacteriology Testing Services Guide
This page last updated 9/10/2021.