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Center for Tuberculosis Control and Prevention

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Center for Tuberculosis Control and Prevention

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General Forms
TB Consultation​ Form
Case/Cohort Review Form
Maryland Guidelines for Tuberculosis Cohort Review
Tuberculosis​ Patient/Provider Agreement - Multiple Languages 
Latent TB Infection Reporting Form​
Latent TB Infection Treatment Record Form 851
Latent TB Infection Treatment Record Discharge Summ​ary - Multiple Languages
TB Follow-Up Worksheet for Class B Waivers​
Video Directly Observed Therapy Sample Consent - Multiple Languages
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Facility Risk Assessment                                                                                                                                                      Local Health Department TB Infection Control Template

Therapeutic Drug Mon​itori​ng Form​s
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Contact Investigations
Contact Investigation Worksheet
Contact Worksheet NEDSS Entry Instructions
Contact Record​
Contact Record Instructions
Location-Based CI Form & Instructions​

National Tuberculosis Controllers Association Transfer Forms​ (NTCA)
NTCA Notification Instructions
Maryland Notification Procedures
Interjurisdictional Tuberculosis Notification Form
Interjurisdictional Follow-up Form​
International Tuberculosis Notification Form​​​​​


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Maryland Department of Health
201 W. Preston Street, Baltimore, MD 21201
(410)767-6500 or 1-877-463-3464
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