Anti-tuberculosis therapy program
- Tuberculosis INFECTION Initial Request for Medication (F-00905) (PDF, 475 KB)
- Tuberculosis DISEASE Initial Request for Medication (F-44000) (PDF, 3.8 MB
- Medication Refill Request (F-44126 "pink sheet")
- Follow Up on Therapy (F-44125 "green sheet")
- TB Suspect Case Data Form (F-42001) (PDF, 223 KB)
- Interjurisdictional Tuberculosis Notification (F-42010)
- Interjurisdictional TB Notification-Follow-up (F-42011)
Contacts
Wisconsin Local Health Departments - Regional offices - Tribal agencies
Respiratory Diseases and International Health Unit
Division of Public Health
Bureau of Communicable Diseases
1 West Wilson Street
Madison WI 53701-2659
608-266-0049 - Secure Fax
Jo Mercurio - Office operations
608-266-9692
Pa Vang - TB nurse consultant
608-266-9452
Philip Wegner - TB nurse consultant
608-266-3729
Norma Denbrook - Dispensary
608-261-6388
Savitri Tsering - Refugee health coordinator
608-267-3733
Last Revised: December 17, 2014
