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.


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.



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 4/25/2023.