Forms for the Public
Registration Form: If you need a tuberculin skin test or chest X-ray to comply with state TB clearance requirements, fill out this registration form and bring it with you to a DOH testing location to save time.
– Hawaii TB Registration Form (Rev. 5/2007)
Forms for Health Care Providers, Facilities, and Institutions
Reporting Forms: If you are a health care provider or facility reporting a suspected or confirmed TB case, fill out the Notifiable Disease Report for Tuberculosis form and fax to TB Registry at 832-5624.
– Notifiable Disease Report for Tuberculosis (Rev. 1/09)
– Tuberculosis Case Follow-Up Report (Rev. 5/10)
– Notifiable Disease Report for Tuberculosis: Definitions and Instructions (Rev. 1/09)
– Reporting Requirements for Suspected or Confirmed Tuberculosis (Rev. 1/09)
Tuberculosis Risk Assessment Form: If you are a health care provider, this is the department-approved form to assess for TB risk.
– Tuberculosis Risk Assessment (Rev. 4/13)
Tuberculosis Symptoms Screening Form: If you a health care provider, this is the department-approved form to screen for signs and symptoms of TB disease.
– Tuberculosis Symptom Screening (Rev. 5/13)