Patient case management
Wisconsin Case Management for Active TB Disease Treatment P-00647 (PDF)
Tuberculosis (TB) Risk Assessment Questionnaire Screen (F-01748)
Anti-tuberculosis therapy
- Tuberculosis INFECTION Initial Request for Medication (F-00905) (PDF)
- Tuberculosis DISEASE Initial Request for Medication (F-44000) (PDF)
- Medication Refill Request (F-44126 "pink sheet") (PDF)
- Follow up on Therapy (F-44125 "green sheet") (PDF)
- TB Suspect Case Data Form (F-42001) (PDF)
- Interjurisdictional Tuberculosis Notification (F-42010) (PDF)
- Interjurisdictional TB Notification Follow-up (F-42011) (PDF)
- Dispensary Pre-authorization for Non-routine TB Services (F-01459) (PDF)
For more information or questions, contact the Respiratory Diseases and International Health Unit or your Wisconsin local health department.
Last Revised: June 5, 2017
