Montana Tuberculosis Forms
Required Reports
Confirmed/Suspected Report of TB Disease
TB Case Monthly Report
TB Contact Investigation Report
TB Contact Investigation Summary
LTBI Medicine Enrollment Form (only if ordering from State TB Program)
Recommended/Available for Active TB Case Management
TB Diagnostic Referral
Treatment Plan
Home Isolation Agreement
Directly Observed Therapy Agreement
Directly Observed Therapy Form 1 – Treatment Record
Directly Observed Therapy Form 2 – Side Effects and Adverse Reactions
TB Home Evaluation
Treatment of Active TB Education
Monthly TB Patient Assessment
Bacteriology Data Sheet
Biochemistry Data Sheet
Recommended/Available for Latent TB Infection (LTBI) Management
Treatment of LTBI Education
Monthly LTBI Patient Assessment
Biochemistry Data Sheet
Transfer Notifications
Interjurisdictional Tuberculosis Notification
Interjurisdictional TB Notification Follow-Up


