Tuberculosis Program Forms

• Anti-Tuberculosis Medication Order Form
• Billing Description Form
• CDC Division of Tuberculosis Elimination Educational & Training Materials Order Form
• College TB risk assessment form
• Contract Reimbursement Statement
• Order for Medical Evaluation for Tuberculosis
• Tuberculin Skin Test (TST) & Treatment Record Blue Cards
  Please contact TB program to order (303.692.2638)
• Tuberculin Skin Testing Material (PPD) Order Form
• Tuberculosis Contact Investigation Record
• Tuberculosis Program Authorization for Release of Information
• Tuberculosis Isolation Order
• Tuberculosis Surveillance and Case Management Report (TB-17)

Tuberculosis Program
Division of Disease Control and Environmental Epidemiology
Colorado Department of Public Health and Environment
DCEED-TB-A3
4300 Cherry Creek Drive South
Denver CO 80246-1530
(303) 692-2638