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NC Department of Health and Human Services
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Tuberculosis

Information for Local Health Departments

Alerts & Hot Topics

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Manuals and Guides

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Support Services

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Forms

  • DHHS:
    • Confidential Communicable Disease Report Form - DHHS 2124 (PDF) - Physicians and healthcare providers may use this form to notify the local health department of reportable communicable disease cases.
    • TB Drug Record- DHHS 1391 (PDF 202KB) Revised Dec 2020
    • TB Epidemiological Record- DHHS 1030 (PDF 215KB) DHHS 1030 Fillable (PDF 1MB) Revised Nov 2020
    • TB Flow Sheet- DHHS 2810 (PDF 216KB) DHHS 2810 Fillable (PDF 974KB) Revised Nov 2020
    • Nursing Record of TB Contacts- DHHS 1662 (PDF 179KB) DHHS 1662 Fillable (PDF 954KB) Revised Dec 2020
    • Record of TB Screening- DHHS 3405 (PDF 243KB) DHHS 3405 Fillable (PDF 796KB) Revised Jan 2021
    • SLPH Mycobacteriology Lab Requisition (DHHS 1247) - Specimens for isolation and identification of all Mycobacterium species (including Mycobacterium tuberculosis complex and other nontuberculous mycobacteria) are accepted from public and private health care providers.
    • TB Biologicals Requisition and Inventory- DHHS 3093 (PDF 217KB) DHHS 3093 Fillable (PDF 245KB) Revised Nov 2020
    • Report of Positive Smear (AFB) and/or Positive Culture of TB- DHHS 3005 (PDF 230KB) DHHS 3005 Fillable (PDF 811KB) Revised Dec 2020
    • Individual Contact Form- DHHS 4097 (PDF 57KB) DHHS 4097 Fillable (PDF 57KB) Revised Jan 2021
  • Other:

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Tools & Websites

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