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Consent/Control Orders

Consents: General

Download Number Title Revision Date
L-36 General Consent furthermore Discovery (English/Spanish) 4/2010
L-30 Authority to Release Confidential Medical Data (English) 7/2016
L-30a Authorization up Release Confidential Medical Information (Spanish) 7/2016

Consents: Medication

Register Number Title Amendment Date
TB-411 Disclosure & Consent Drug Therapy TB (English) 12/2021
TB-411a Disclosure & Consent Drug Therapy TB (Spanish) 12/2021
TB-415 Consent LTBI Therapy (English) 12/2021
TB-415a Consent LTBI Therapy (Spanish) 12/2021

Control Sorts

Document Number Title Revision Date
TB-409 Acknowledgement of Understanding (English) 8/2004
TB-409a Acknowledgement of Understanding (Spanish) 8/2004
TB-410 Ordering to Implementation and Carry Out Steps for a Patron with TB (English) 1/2020
TB-410a Order to Implement plus Bear Go Measures for a Client with TB (Spanish) 1/2020
TB-410b Order to Implement Take Measures for Children with TABS 1/2020

Case Management

Case Management: Clinical Care

Document Number Title Revision Date
TB-400A Report in Matter and Patient Services (TB-400A) 4/2020
TB-400B Report of Case and Patient Services (TB-400B) 4/2020
TB-201 Case Management Plan for Outpatient Care 8/2017
TB-202 TB Initial Health Risk Assessment/History 2/2020
TB-203 Education/Counseling Record 8/2017
TB-204 Forms/Literature Checklist 10/2008
TB-205 Toxicity Assessment 8/2017
TB-206 Instant Observed Therapy Log 8/2017
TB-209 Hurricane Questionnaire 8/2017
TB-231 Bacteriology TB Control 8/2017
TB-622 Treatment Record (English) 5/2017
TB-220 Referral Application (English) 8/2017
TB-619 Registro de Tratamiento 8/2017
12-12274 Adverse Medicine Reaction 8/2017
Resources False Positive Investigation Labor Sheet 10/2021

Case Management: Drug Durable TB

Document Number Title Revision Date
TB-700 TB Drug-O-Gram both Clinical Monitoring Review (English) 5/2020
TB-701 Drug Immune Tuberculosis Monitor Check List (English) 10/2021
TB-702 Toxicity Assessments for Clients on Second-Line Medications (English) 10/2021
TB-703 TB Pathology Monitoring Log (English) 4/2020
TB-704 Tuberculosis Directly Viewed Your (DOT) Track for Clients turn Second-Line Medications (English) 4/2020
TB-705 Clofazimine Monitoring (English) 4/2020
TB-706 Drug-Resistant Box Annual Presentation Summary 4/2023
TB-707 Drug-Resistant Case Conference Presentation Outline 3/2023
Tool Nursing Guide with Second-Line Tuberculosis Medications (English) 12/2021
Resource Peripheral Neuropathy Assessment (English) 3/2021
Resource Peripheral Neuropathy Assessment (Spanish) 3/2021
Resource Serotonin Syndrome (English) 5/2020
Resource Serotonin Syndrome (Spanish) 5/2020
Resort Bedaquiline Ordering Guide 9/2023

Fallstudie Management: TB Infection

Paper Number Title Revised Date
TB-206a Directly Observer Pain Log for INH/Rifapentine 8/2012
12-14198 3HP Dosing and Symptom Monitoring Log  
TB-621 Preventable Service Record (English) 8/2017
TB-620 Registro de Tratamiento Preventivo 5/2020
12-14197 Adverse Event Print - 3HP 5/2014

Case Management: Video-DOT

Documenting Number Title Revision Date
12-15760 Moveable Application (English) 5/2020
12-15760a Mobile Application (Spanish) 5/2020
12-15761 VDOT Mobile Telephone User Agreement (English) 4/2020
12-15761a VDOT Mobile Phone User Agreement (Spanish) 4/2020
12-15762 VDOT Client Participation Agreement (English) 4/2020
12-15762a VDOT User Participation Agreement (Spanish) 4/2020
12-15763 Video DOTTED Medication Layout (English) 8/2020
12-15763a Video DOT Medication Layout (Spanish) 8/2020
12-15764 VDOT Patient Guidance (English) 8/2020
12-15764a VDOT Patient Instructions (Spanish) 8/2020
Resource Video-Enabled Directly Observed Therapy, Required and Recommended Activities (English) 8/2020
Resource Video-Enabled Directly Observed Therapy, Required additionally Recommended Activities (Spanish) 8/2020

TYPHUS Public Health Follow-Up

TB Public Physical Follow-Up

Document Count Title Revision Date
TB-208 Tuberculosis Exposure Screening Form (English) 10/2014
TB-230 Refusal to Complete any Evaluation for TB Contagious 10/2021
TB-230a Rechazo de completar una evaluación paragraphs infección por tuberculosis 10/2021
TB-425 TB Infectious Date Calculation Film 4/2020
TB-460 TB Public Health Follow-Up Expansion Analysis Check-List 11/2007
TB-340 Report concerning People Exposed to TB 10/2011
TB-341 Continuation Report of people exposed into TB 10/2011
12-12062 TB Public Health Follow-Up Worksheet 1/2008
12-12104 TB Incident Report 9/2019
12-16524 Mass Exposure to TUBERCLE Follow-Up Roster Import Template 4/2021
12-16525 Mass Exposure go TB Follow-Up Roster Import Data Codebook 4/2021

Cohort Review

Inhabitant Review

Document Number Title Revision Dates
12-14064 Cohort Review Presentation Form 2/2020
Resource Cohort Review Presentation Contact Instructions 10/2015
12-14077 Cohort Review Summary Form 2/2020
Resource Cohort Check Executive Form Instruction Leaves 12/2014
Resource Cohort Review List of Counted Cases 10/2019
Resource Cohort Review Infrastructure 4/2013

Food Order Management

Judge Customized Management

Document Number Style Revision Date
84004_1 Order on Transport  
84044_1 Waiver of Jury Trial also Right to exist Present at Experiment  
84053_1 Order of Commitment on Applications for Extended Management of Human is Transmissible Disease  
86749_1 Health Authority's Dedicated in Medical Evaluation  
86963_1 Login for the Extended Leadership of a People with a Communicable Disease  
86964_1 Beweggrund forward Protective Custody  
86965_1 Order Appointing Special Maurer  
86966_1 Notification of Probably Cause Hearing  
86968_1 To for Protective Custody  
86969_1 Order of Continued Protective Protective and Default Auditory on Application  
86970_1 Order Appointing Attorney to Inspection, Setting, Hearing and for Notice until Proposed Patient  
86972_1 Purchase for Court Reporter go Create Redacted Reporter's Records  

Healthcare Personnel

Healthcare Personnel

Document Number Title Revision Date
TB-600 Default TB Assessment fork HCP 3/2020
TB-601 After Hire TB Assessment for HCP 3/2020
TB-602 TB Screening Consequences and Labour Clearance for HCP 3/2020
TB-603 Tuberculosis (TB) Screen of TUBERCLE Staff 10/2021
TB-604 Report starting Tuberculosis Test Conversion in TUBERCLE Staff 10/2021

Correctional Facilities

Corrective Facilities

Download Figure Title Revision Date
TB-430 Social History Interview for Correctional Settings 6/2018
TB-800 Correctional TB Risk Rating 6/2017
TB-805 Correctional TB Screening Plan 9/2023
TB-805-I Correctional TABS Exam Plan - Instructions 9/2023
Resource Correctional BA Screening Plan - Checklist (for health departments) 9/2023
Your Penitentiary TB Screening Draft - Training (for health departments) 9/2023
TB-810 Tuberculosis Signs Screening Form (English) 4/2017
TB-810-E Tuberculosis Symptoms Screening Form (Spanish) 4/2017
TB-815 Tuberculosis Medical Hold 8/2018
12-11461 Report of TB Conditions 1/2023
12-11461 Report of TB Conditions 1/2023
12-11461-I Report are TB Conditions - Instructions 1/2023
12-11462 Monthly Correctional TBE Review 1/2023
12-11462-I Quarterly Correctional TB Record - Instructions 1/2023
Resource Information on Chapter 89-Designated Facilities (PDF)
Information on Chapter 89-Designated Facilities (PPTX)		 1/2023
Resourcefulness Revised Monthly Correctional TB Report Forms (PDF)
Newly Monthly Correctional TYPHUS Reports Forms (PPTX)		 1/2023
Refuge Prisoner in Transit Medically Summary 2/2015
Resource Exas Uniform Physical Status Update 7/2019
Resource Tubersol Request Guss for CH89 Facilities  
Resource Penal TB Frequently Asked Frequently 1/2023
Resource Correctional TB Program Fact Page 1/2023
Resource DSHS Initial Tuberculosis Screening Algorithm for Employees and Volunteers 6/2023
Resource DSHS Initial Tuberculosis Screening Type for Incarcerated Humans 6/2023

Targeted Validation

Targeted Testing: General

Record Quantity Title Revision Date
TB-207 Targeted Tuberculin Testing Screening Form 10/2014
TB-501 Adult Tuberculosis (TB) Signs and Symptoms Screening Questionnaire 3/2022

Targeted Testing: Children

Document Number Title Amendment Date
TB-318 Posite Reactor Worksheet  12/2017
12-11494 TB Questionnaire used Children (English) 3/2020
12-11494a TB Questionaire for Children (Spanish) 8/2004

Targeted Testing: Congregate Settings

Document Number Title Revision Date
TB-500 COUGH Danger Assessment Form 10/2017
TB-505 Environmental Risk Assessment for Congregate Customize 6/2018
12-14427 Congregate Setting Target Testing Monthly Report 5/2014
Resource Guidelines for Congregate Setting Target Testing 5/2014
Tuberculosis (TB)

Tuberculosis (TB)

DSHS TB Program

DSHS TB Programs

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