May 20, 2022: the Centers for Disease Control and Prevention listed six Connecticut Counties in the High/Orange category as part of its COVID-19 Community Levels Map. Only Fairfield and Tolland Counties are listed in the Medium/Yellow category. Residents in these counties should wear a mask indoors in public; stay up to date with COVID-19 vaccines and get tested if they have symptoms. Additional precautions may be needed for residents who are at high risk for severe illness. Visit the CDC COVID-19 Community Levels Map for updates.

Tuberculosis Control Program Forms

   
 

TB Surveillance Report Form (and instructions)
 
For initial TB Disease and LTBI Reporting.

TB Treatment and Follow-up Care Report Form (and instructions)

For all subsequent reporting on TB disease/suspect cases and LTBI.

Instructions

TB Discharge and Treatment Plan Form (and instructions)


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.

TB Patient Discharge Plan with Instructions

Contact Investigation Worksheet and Instructions

For reporting persons who are contacts to a TB patient with active disease during the established infectious period.

Worksheet

Instructions

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.

Risk Assessment and User Guide

How to use this tool

  

TB Billing Forms

State Public Health Laboratory Forms/Reports (selected)

 

This page last updated 9/10/2021.