TB Program Forms and Documents

CDU TB Program Forms and Documents

Contact Info:

 

EMAIL: cdu.treatment@wyo.gov

 

CONFIDENTIAL FAX: 307-777-5279

 

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TB Program Forms and Documents

  1. Patient Risk Assessment
  2. TB Skin Test Not Indicated – Letter
  3. CDU TB Program Prior Authorization Request Form
  4. 2025 Possible or Confirmed ACTIVE TB Home Isolation Evaluation
  5. 2025 Possible or Confirmed ACTIVE TB Home Isolation Agreement
  6. 2025 TB Program Patient Medication List
  7. 2025 TB Medication Education Form
  8. 2025 TB Treatment Agreement
  9. 2025 TB Clinical Assessment and Medication Monitoring
  10. 2025 Latent TB Treatment Record
  11. 2025 Latent TB Treatment Completion or Discontinuation Letter
  12. 2025 Active TB Treatment Record
  13. 2025 ACTIVE TB Treatment Completion or Discontinuation Letter