Form PH-49 Latent Tuberculosis Checklist - Nebraska

Form PH-49 Latent Tuberculosis Checklist - Nebraska

What Is Form PH-49?

This is a legal form that was released by the Nebraska Department of Health and Human Services - a government authority operating within Nebraska. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form PH-49?
A: Form PH-49 is the Latent Tuberculosis Checklist used in Nebraska.

Q: What is latent tuberculosis?
A: Latent tuberculosis is a condition where a person has the TB bacteria in their body, but it is inactive and they do not have any symptoms.

Q: Who needs to fill out Form PH-49?
A: Individuals who have been identified as having latent tuberculosis or who are at risk for latent tuberculosis need to fill out Form PH-49.

Q: What is the purpose of Form PH-49?
A: Form PH-49 is used to assess the risk of developing active tuberculosis and to determine the need for further testing or treatment.

Q: What information is required on Form PH-49?
A: Form PH-49 requires information on the individual's personal and medical history, as well as any previous TB tests or treatments they have received.

Q: Who should I contact if I have questions about Form PH-49?
A: If you have questions about Form PH-49 or latent tuberculosis, you should contact your healthcare provider or the Nebraska Department of Health and Human Services.

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Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Nebraska Department of Health and Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form PH-49 by clicking the link below or browse more documents and templates provided by the Nebraska Department of Health and Human Services.

Download Form PH-49 Latent Tuberculosis Checklist - Nebraska

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