Center for Tuberculosis Control and Prevention

Forms

National Tuberculosis Controllers Association (NTCA) Transfer Forms

State of Maryland, Tuberculosis Patient/Provider Agreements

[Two (2) copies should be signed. One kept by the patient, and one kept by the provider in the patient’s record.]

[Regarding patient/provider agreements in foreign languages, given the diversity of dialects and cultures for certain languages (e.g., Spanish and French); if a patient reads the agreement and does not understand it, a translator is needed in person or over the telephone, to suitably explain the agreement for the patient. These agreements are not meant to substitute for a translator.]