Tuberculosis Disease Initial Request For Medication Page 3
Download a blank fillable Tuberculosis Disease Initial Request For Medication in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Tuberculosis Disease Initial Request For Medication with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4Wisconsin Tuberculosis (TB) Program
Guidance for use of Dispensary and Medication Funding
The Wisconsin Tuberculosis (TB) Program manages and facilitates the various activities and
interventions necessary to assure identification and proper treatment of all individuals with TB to
eliminate its subsequent spread to others. The TB Program provides medication and
educational services to prevent and control infection and disease caused by Mycobacterium
tuberculosis. Persons with latent TB infection (LTBI), suspected of, or with confirmed TB
disease, or household contacts of infectious TB patients may receive anti-TB medication
through their local health department. In an effort to provide care for the most vulnerable
portions of our population we ask that you keep the following points in mind when using the TB
dispensary.
Who should be tested and/or treated?
The main risk factors of TB infection and disease in Wisconsin are:
Knows or knew someone with active TB disease
Foreign born; especially from high-risk countries where the TB incidence is over
20/100,000
o ie.,Laos/Thailand/Philippines/Malaysia/Burma/Bhutan/India/China/Africa/Mexico/
Myanmar/former USSR.
Eligibility Criteria for using the TB Medication Program and TB Dispensary Program
The TB Program has a limited budget to reimburse local health departments for medical
management of TB cases, suspects, and those with LTBI. The TB Program prioritizes the use
of funds for those with the following criteria:
Confirmed diagnosis of TB disease
TB suspects
Known contacts to active TB case
Foreign born from high-risk countries
Risk factors for progression of infection to active TB case (ie., HIV positive or going to
receive TNF-α antagonist)
The dispensary does not reimburse for testing of employees, students, or initial hires that do not
have any of the above risk factors. The TB Dispensary limits the reimbursement for low-risk
individuals with no known risk factors. Use of the TB Dispensary funds for low-risk individuals
or fully insured persons diminishes the ability to provide services for high risk individuals.
We ask for your cooperation in limiting the use of the TB program funds to cases of
tuberculosis, suspects, contacts, and LTBI patients with a high risk of progression to active
disease.
Updates on the Initial Request for Medication (IRM) Forms
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical