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Report suspected or confirmed tuberculosis cases

Reporting of all patients with confirmed or suspected TB is legally required by California Code of Regulations, Title 17, Section 2500. Reports must be submitted within one working day of identification of the confirmed or suspected case.

  • Use this Confidential morbidity report (CMR) to report outpatients, children less than 2, and people who work or live in a health care setting with Latent TB Infection.
  • Use this Confidential Morbidity Report for reporting Latent TB Infection (LTBI).
  • Use the GOTCH form for inpatients. You can use the same GOTCH form you used to make the initial report and update it to request discharge approval later.

The County of Santa Clara Public Health Department TB Prevention and Control Program investigates all reports of persons with suspected or confirmed TB disease. Therefore, reporting cases of suspected or confirmed tuberculosis is vital to protect public health as it allows the Health Department to intervene in order to interrupt disease transmission. The TB Program also investigates close contacts to patients with infectious TB to identify any other individuals with TB infection and refer for appropriate treatment.

Select a topic to learn more about reporting TB cases.

Who must report?
Which patients must be reported?
What happens after I report the case?
GOTCH law for inpatients at health care or correctional facilities
Required documentation for GOTCH approvalReporting out-of-county patients and re-admitted patients

Who must report?

  • All health care providers knowing of or in attendance on a patient suspected or confirmed to have tuberculosis disease must report within 1 working day from the time of identification, as per California Code of Regulations, Title 17, Section 2500.
  • The director or designee of any clinical laboratory must report laboratory evidence suggestive of tuberculosis to the Local Health Department for the jurisdiction of the health care provider within 1 working day of notification of the ordering provider or referring laboratory, as per California Code of Regulations, Title 17, Section 2505.
 

Which patients must be reported?

All patients with suspected or confirmed TB must be reported within one (1) working day from time of identification. That is, report the case when the following conditions are present; do not wait for laboratory results to confirm the diagnosis prior to reporting.

  • Symptoms or signs of TB; and/or
  • Radiologic findings consistent with TB; or
  • The patient is placed on two or more anti-TB drugs due to clinical suspicion of TB.

     -OR- 
 
  • AFB smear or culture demonstrate acid-fast bacilli; or 
  • Molecular diagnostic testing (for example, Xpert MTB/RIF or other PCR) is positive for Mycobacterium tuberculosis complex; or
  • Positive culture for M. tuberculosis complex (M. tuberculosis, M. bovis, M. africanum, M. microti, M. canetii, M. caprae, and M. pinnipedii); or
  • Pathology report is consistent with tuberculosis (granulomas or positive AFB stain).​ 

Latent TB Infection is only reportable for persons with:

  • TST/IGRA conversion who live or work in a health care setting;
  • Children under two years old.

What happens after I report a case?

A Public Health Nurse Case Manager is assigned to every patient during their treatment to:

  • provide individualized case management;
  • provide education and support;
  • help ensure that TB is not spread further;
  • address barriers to treatment adherence;
  • monitor clinical progress and symptoms of possible medication side effects;
  • ensure treatment completion. 
 

GOTCH law for inpatients at healthcare or correctional facilities

Prior to the discharge or transfer of patients with confirmed or suspected TB, California Health and Safety Code Section 121361 requires all health care facilities, including hospitals, skilled nursing facilities, and nursing homes, and correctional facilities to obtain written approval of the treatment plan by the Health Officer (Tuberculosis Controller) of the county in which the facility is located. This does not apply when there is an immediate need to transfer for a higher level of care, nor to transfer from a health care facility to a correctional institution.

Fax the GOTCH form to the TB Prevention and Control Program at (408) 885-2331, then call (408) 885-2440 to verify receipt. 

 

The TB Program has 24 hours to review the GOTCH form. To make a request after-hours, you must contact the Health Officer on-call via County Communications: (408) 998-3438. 

To expedite approval, please submit an initial GOTCH form along with pertinent medical records as soon as a patient is suspected to have TB. When a GOTCH form is received, a Public Health Nurse Case Manager is assigned and begins the evaluation of the household to ensure a safe transition home for patients and their families.

Documentation for GOTCH approval

The following documentation is routinely requested prior to GOTCH approval. Please provide as soon as possible to facilitate discharge:

  • Physician notes, including any Infectious Diseases or Pulmonary consultation;
  • Medication list, including TB medication dosages and non-TB medications;
  • Documented current weight;
  • Radiology reports;
  • Diagnostic testing for TB. Examples include AFB smears/cultures, molecular diagnostic tests, pathology and cytology reports, body fluid (pleural/ peritoneal/ pericardial/CSF) chemistries and cell counts.
 
  • TST/IGRA results. These tests cannot exclude active TB disease, but are utilized for Public Health Reporting to CDC;
  • HIV test results. Testing is recommended for all patients with suspected TB before treatment initiation; for patients with risk factors, results of chronic Hepatitis B/C screening;
  • Baseline laboratory tests: CBC, Chem 7, LFTs;
  • For patients suspected to have TB without laboratory confirmation, any other diagnostic evaluation performed such as fungal serologies, and cultures.

GOTCH submissions

Out-of-county TB patients

Submit initial and discharge GOTCH forms to us at the Santa Clara County Public Health Department. In turn, we will notify and update the Health Department for the county in which the patient resides. When discharge is requested, the County of Santa Clara will inform the other county and ensure they are in agreement before signing the GOTCH form. 

Given this involved process, we recommend submitting the discharge GOTCH at least two days before the anticipated discharge date.

Re-admitted TB patients  

You are required to submit the GOTCH form any time a patient with confirmed or suspected TB is discharged or transferred from a healthcare or correctional facility, including when patients being treated for TB are readmitted to the hospital. 

Notification of rehospitalization is helpful to alert the assigned Public Health Nurse and DOT worker; verify TB medication dosages; help assess whether there are issues related to TB or TB medications, including any new significant drug interactions; and to resume DOT after the patient is discharged.