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Ascension screening tool12/16/2023 ![]() ![]() TB Risk Assessment Questionnaire, F-02314 (also in Spanish): A worksheet to determine a person's risk for TB infection and disease. ![]() Wisconsin TB Treatment Assistance Program Wisconsin Medicaid and BadgerCare Plus TB-Related Services Only, P-10022: See this fact sheet for information on the TB-services only Wisconsin Medicaid plan (available in Dari, Hmong, Burmese, Kirundi, Russian, Spanish, and Ukrainian).TB Ordering and Billing Interface (TOBI) User Security and Confidentiality Agreement, F-02163: Fill out this form and return to the WTBP for access to TOBI.Ordering Active Tuberculosis Medications through the Wisconsin TB Dispensary Program, P-02404A: Instructions for order medications for active TB disease through the Wisconsin Dispensary Program.Ordering Latent Tuberculosis Infection (LTBI) Medications though the Wisconsin Tuberculosis Dispensary Program, P-02404: Instructions for ordering LTBI medications through the Wisconsin TB Dispensary Program.Medication Refill Request, F-44126: (PDF) Fill out this form to request a refill on medication for active TB disease from the Wisconsin TB Program Dispensary.TB Infection Initial Request for Medication, F-00905: (Word) Fill out this form to request medication for LTBI from the WTBP.TB Disease Initial Request for Medication, F-44000: (PDF) Fill out this form to request medication for active TB disease from the WTBP. ![]()
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