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)

Reporting Guidance
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)

 
This page last updated: July 16, 2014