- DOT Invoice (fillable form)
- DOT Reimbursement Breakdown
- TB-9 X-Ray Record Card
- TB-15-P Monthly Tuberculin Testing Report - PRIVATE PAY
- TB-15-S Monthly Tuberculin Testing Report - STATE SUPPORTED
- TB-18 Medication & Supply Order Form
- TB-21 Clinic Activity Sheet
- TB-34 Individual Tuberculosis Reporting Form
- TB-50 Medication Dispensing Record
- TB-60 TB Test and Treatment Record
- TB-61 Return for Tuberculin Skin Test Reading
- TB-70S School Nurse Referral to LHD
- TB-80 Diagnostic Clinic Form
- TB-101 LTBI Reporting Form
- TB-102 LTBI Refusal - Adult
- TB-103 LTBI Parental Refusal
- TB-104 Risk Assessment
- TB-106 Consent for Treatment: Common Meds | Uncommon Meds
- TB-107 DOT Treatment Record
- TB-109 Active or Suspect Pathway
- TB-110 LTBI Pathway
- TB-112 Report of Tuberculosis Screening
- TB-113 Free of TB Letter
- TB-115 Smear Culture Log
- TB-117 LFT Monitoring Log
- TB-150 Workers Log
- TB-1001 Contact Sheet
- Treatment Plan for Active Tuberculosis
- Treatment Plan for LTBI
- Consent to Participate in Live Video DOT
An Official West Virginia Government Website
350 Capitol Street
Room 125
Charleston, WV 25301
United States