Forms

Report of Verified Case of Tuberculosis (RVCT; a 32 kb .pdf document)
The RVCT form is used by the county health departments to report a case of active TB disease to the state health department. The information contained in this form is a good beginning to gathering what the county will need to provide follow-up for active TB cases. According to Michigan's Communicable Disease Rules, physicians are required to report laboratory confirmed cases of active TB as well as suspect cases to their local county health department within 24 hours of diagnosis. In turn, counties must forward this information to the State TB Control Program within seven days of receipt.

RVCT-Follow-Up 1 (a 156 kb .pdf document) The Initial Drug Susceptibility Report.

RVCT-Follow-Up 2 (a 214 kb .pdf document)  The Case Completion Report.

B1 B2 Notification Information

(a 25 kb .pdf document)

The B notificaiton program is an important screening strategy to identify immigrants and refugees who have a high risk for TB.  This document gives information on the follow-up and assessment of persons with Class B1/B2 TB.

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The Interjurisdictional TB Notification system facilitates and standardizes interstate communication in order to enhance continuity and completeness of care. When a client moves in or out of state, the appropriate form should be completed by the local health department and mailed or faxed to our State TB Control Program at the Michigan Department of Community Health. The information will then be forwarded to the appropriate state personnel.

NTCA Interjurisdictional Tuberculosis Notification Form (a 26 kb .pdf document)
This form provides a standard array of information to be sent to new jurisdications for active and suspect cases, contacts, and persons with LTBI.

NTCA Interjurisdictional Followup Form (a 68 kb .pdf document)
This form provides follow-up information to be transmitted to sending jurisdictions.