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Communicable Disease Nurse
Consultants (PDF, 33KB)- Regional Medical Consultation Unit staff supporting
LHD Communicable Disease Nurses across the state.
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 204KB) Revised May 2025
TB Epidemiological Record- DHHS
1030 (PDF 344KB) Revised May 2025
TB Flow Sheet- DHHS
2810
(PDF 235KB) Revised May 2025
Nursing Record of TB Contacts- DHHS
1662 (PDF
199KB) Revised May 2025
Record of TB Screening- DHHS
3405 (PDF 227KB) Revised May 2025
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 643KB) Revised May 2025
Report of Positive Smear (AFB) and/or Positive Culture of TB- DHHS
3005 (PDF 362KB) Revised May 2025
Individual Contact Form- DHHS
4097 (PDF 147KB) Revised May 2025
Tuberculosis report worksheet for Healthcare
Providers (PDF, 102KB) - The N.C. Tuberculosis Control Program has developed this
worksheet to help hospital infection control nurses and other healthcare providers organize
and quickly reference the information they will need to provide the local health department
when reporting a suspected or confirmed tuberculosis case.