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Online TB Reporting Forms

The Indiana Prevention and Care Program has the following forms available online:

Report of Tuberculosis

Summary of Changes to the TB Reporting Form

For NBS Users: Supplemental Form for New Reporting (RVCT) Items

Report of Latent Tuberculosis Infection

Monthly TB Follow Up Report
Tuberculosis Waiver Request

Interjurisdictional TB Notification (IJN) Forms:
Revised IJN forms were released in August 2022. A companion document is available that walks through how to use the updated IJN forms.
Cover Sheet: One page that can be used for all referrals
TB Disease/Possible TB: Two pages summarizing the patient status
TB Contact: One page summarizing contact demographic information (or exposure setting information) and details about index cases (smear/culture/DST)
TB Infection: One page for latent TB infection