If I Do a Tbs and Its Not Expire and I Go to Work Another Place Do I Have to Do Over Again

For the General Public:

What is TB?
What are the symptoms of TB?
How is TB spread?
Is there a deviation betwixt TB Infection, and TB illness?
What should I do if I have spent time with someone with TB infection?
What should I do if I have been exposed to someone with TB disease?
How do I become tested for TB?
Who can administer a tuberculin skin examination (TST)?
How ofttimes can TSTs be repeated?
Where tin can I go tested for TB?
What does a positive TB test mean?
Tin can I get vaccinated for TB?
What if someone has received the BCG vaccine (which is given in many countries)?
Why is TB infection treated?
How is TB disease treated?
How many people in Texas have TB?

For Health Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon rent?
How often should HCP be screened for TB after hire? Is almanac testing recommended?
If annual testing with a TST or blood exam is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?
How should I screen my employee for TB upon rent if they say they already have a positive TB skin or blood test?
Tin a new rent's documented negative tuberculin skin test (TST) upshot be used in performing a baseline two-step TST?
What practise I demand to know if my HCW has received a BCG vaccine?
Are routine or annual CXRs however recommended?
Can my employee with a positive TB skin or blood examination return to work?
What further deportment practise I need to take when HCP are diagnosed with TB infection or TB disease?
Should HCP be treated for TB infection?
Have the updated 2019 guidelines for screening HCP for TB changed the demand for a facility chance assessment?
Does DSHS have a sample course that health care facilities may employ to document TB screening, testing, and didactics?
Where tin I detect more information regarding screening health care personnel for TB?

TB and COVID-19

Do COVID-xix and TB share like symptoms?
Are there recommendations to delay TB screening in persons recently vaccinated against COVID-19?

General Reporting Requirements

How do I study tuberculosis screening results?

Recommendations for TB Screening of Adults and Children in Various Settings

Are in that location general recommendations about which adults should and should not be screened for TB in Texas, and how to screen them?
Are at that place general recommendations nigh which children should and should not exist screened for TB in Texas, and how to screen them?
What are the screening requirements for TB testing in facilities that provide care to children?
What are the screening requirements for TB testing in adult care centers such every bit assisted living facilities?

For Schools

Do all employees in Texas schools still demand a tuberculin skin exam?
Practice all new students in Texas schools still need a tuberculin peel test?

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

Other Resources

What are other recommended sites where I tin find information almost tuberculosis?

For the General Public

What is TB?

Tuberculosis (TB) is a disease caused by germs that spread from person to person through the air. TB usually affects the lungs, but it tin also affect other parts of the body, such equally the brain, the kidneys or the spine. A person with TB tin dice if they do non get treatment.

What are the symptoms of TB?

The general symptoms of TB disease include:

Feelings of sickness or weakness
Weight loss
Fever
Dark sweats.

The symptoms of TB illness of the lungs also include:

Coughing
Chest pain
Coughing up blood

Symptoms of TB disease in other parts of the body depend on the area afflicted.

How is TB spread?

TB germs go into the air when a person with TB disease of the lungs or throat coughs, sneezes, speaks, or sings. These germs tin can stay in the air for several hours, depending on the surroundings.  People who breathe in air containing these TB germs tin get infected. This is chosen TB infection or latent TB infection (LTBI). If untreated, TB infection can become TB affliction.

Is there a difference betwixt TB Infection, and TB disease?

People with TB infection accept TB germs in their bodies, simply they are not sick because the germs are not active. These people do not have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB illness in the future. They are often prescribed handling to prevent them from developing TB illness.

People with TB disease are sick from TB germs that are active, meaning that they are multiplying and destroying tissue in their body. They unremarkably accept symptoms of TB disease. People with TB disease of the lungs or throat are capable of spreading germs to others. They are prescribed drugs that tin can treat TB disease.

What should I practise if I have spent time with someone with TB infection?

A person with TB infection cannot spread germs to other people. You do not need to exist tested if you accept spent fourth dimension with someone with TB infection. All the same, if you lot have spent fourth dimension with someone with TB affliction or someone with symptoms of TB, y'all should contact your doctor or local or regional health department for TB screening recommendations.

What should I do if I have been exposed to someone with TB illness?

Non everyone who is exposed to TB becomes infected with the TB germs. If yous believe you have been exposed to TB, y'all should contact your physician or the local wellness department for more information well-nigh screening and testing.

How practice I become tested for TB?

There are two tests that tin can be used to help detect TB infection: a skin exam or a TB blood test.

The Mantoux tuberculin pare test (TST) is performed by injecting a modest corporeality of fluid (called tuberculin) into the pare in the lower function of the arm. A person given the TST must return within 48 to 72 hours to have a trained health care worker wait for a reaction on the arm; this must be done in-person.

The TB blood test, known as the Interferon Gamma Release Analysis (IGRA), measures how the patient'south immune organisation reacts to the germs that cause TB when nowadays. There are currently two Federal Drug Assistants (FDA) approved blood tests on the market: the QuantiFERON®–TB Golden In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

Although the tuberculin skin test has been the most common screening method in Texas, many health departments now use the IGRA exam equally the standard tool. When choosing a skin exam or blood test, consideration can be made based on age, health condition (see policy TB 1004), BCG status, and other factors of the person needing the test.

A positive TST or IGRA only tells you if yous have TB germs in your body. Other tests may be needed to tell if you take TB illness, such as a chest 10-ray (CXR) and other laboratory testing of sputum.

Who can administer a tuberculin peel test (TST)?

A tuberculin peel test (TST) is considered a medical act and should only exist performed by an individual working under the order of a licensed physician. At that place is no requirement for the individual to be a licensed health care worker. DSHS recommends those that administer a TST run across cognition and clinical skills requirements, have received training, and demonstrated competency before administering a TST.

The Texas DSHS TB Programme recommends that anyone who administers a TST has reviewed, is familiar with, and able to readily access the recommendations within the post-obit documents:

CDC Fact Sheet "Tuberculin Pare Testing"
CDC fact sheet "Targeted Tuberculin Testing and Interpreting Tuberculin skin Exam Results"
CDC Mantoux Tuberculin Skin Testing Facilitator Guide
Tubersol package insert (PDF)
Aplisol package insert (PDF)

In person training on how to administrate a TST is bachelor through the Heartland National TB Middle. For a listing of TB training opportunities, visit the Heartland National TB Center website.

How ofttimes can TSTs be repeated?

In general, in that location is no risk associated with repeated tuberculin skin test placements. If a person does not return inside 48-72 hours for a tuberculin pare test reading, a second test can be placed as soon as possible. At that place is no contraindication to repeating the TST, unless a previous TST was associated with a astringent reaction.

Where can I get tested for TB?

In full general, Texas Department of State Health Services does not recommend that low risk individuals exist tested for tuberculosis. If a test is needed or recommended, the general public may ask their primary care provider, local clinics, or pharmacies, among other sites. Y'all may too contact your local or regional wellness department for recommendations regarding individual testing needs.

What does a positive TB exam hateful?

A person with a positive TST or blood test has the TB germ in their body. Information technology does non tell whether or non the person has TB infection or TB disease. Other tests, such as a breast ten-ray, symptom screening and a testing of sputum (phlegm), are needed to make up one's mind whether the person has TB infection or TB illness.

Can I get vaccinated for TB?

There is a vaccine for TB, but it is not by and large recommended for use in the United States. Bacille Calmette-Guérin, or BCG, is a vaccine used in many countries with loftier rates of TB. BCG vaccination does non completely prevent people from getting TB, but information technology is used to protect infants and immature children from serious, life-threatening diseases, specifically miliary TB and TB meningitis.

What if someone has received the BCG vaccine (which is given in many countries)?

In many parts of the earth where TB is mutual, Bacille Calmette-Guérin, (BCG) vaccine is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis. However, it does not completely prevent people from getting TB.

The effect of the BCG vaccine wanes overtime and may accept little to no consequence on positive TST results among adults who received the vaccine as a child.

A person with a history of BCG vaccination can be tested and treated for TB infection if they react to the TST. TST reactions should be interpreted based on risk stratification regardless of BCG vaccination history. IGRAs utilise M. tuberculosis specific antigens that practice not cross react with BCG, and therefore, exercise not cause false positive reactions in BCG recipients— this means a blood exam, or IGRA, is preferred for BCG vaccinated individuals.

Why is TB infection treated?

If you have TB infection but not TB disease, your doc may desire y'all to have a drug to kill the TB germs and prevent you from developing TB disease. The decision about taking treatment for TB infection will be based on your chances of developing TB disease. Some people are more likely than others to develop TB disease once they have TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with certain medical conditions.

How is TB disease treated?

TB illness can be treated past taking multiple drugs for several months, more often than not 6 to 12 months. Information technology is very important that people who have TB disease stop the medicine, and take the drugs exactly as prescribed. If they stop taking the drugs too shortly, they can become sick once more; if they practice non have the drugs correctly, the germs that are even so alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. In some situations, local health department staff meets regularly with patients who have TB to lookout them have their medications. This is called directly observed therapy (DOT). DOT helps the patient complete treatment in the to the lowest degree amount of time.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB disease. Also, people who are presumed to take TB may exist given treatment while their clinicians perform further testing to confirm or rule out TB disease.

How many people in Texas accept TB?

Each year, DSHS provides data on numbers of TB cases per canton. The most current information is found on the TB statistics page.

For Health Intendance Professionals

What are the recommendations for screening wellness care personnel (HCP) for tuberculosis upon hire?

The Section of State Health Services (DSHS) in partnership with the National Tuberculosis Controllers Clan (NTCA) and Centers for Disease Control and Prevention (CDC), recommend that both paid and unpaid wellness intendance personnel (HCP) receive the following upon rent:

A single claret test known equally an interferon gamma release assay (IGRA) or a two-step tuberculin pare test (TST);
An individual take a chance assessment to decide baseline risk for TB and interpret the IGRA or TST results; and
A signs and symptoms screening assessment.

DSHS developed a sample Baseline Tuberculosis Assessment for Health Care Personnel grade (PDF) that may be used by wellness care facilities. DSHS also recommends completing the Tuberculosis Screening Results and Work Clearance for Health Care Personnel (PDF) subsequently performing a baseline TB assessment.

These recommendations may be used by health intendance facilities and other entities to guide the development of their internal TB screening policies. These recommendations should not be interpreted as DSHS policies.

Later on hire, how ofttimes should HCP be screened for TB? Is annual testing recommended?

Annual TB testing using an IGRA or TST is not routinely recommended. Health care facilities should perform TB testing and complete a signs and symptoms assessment later known or ongoing exposure to TB or complete a signs and symptoms assessment annually for HCP with untreated TB infection. HCP should likewise be educated about TB treatment options for TB infection.

Nosotros adult a sample After Rent Tuberculosis Assessment for Health Intendance Personnel grade (PDF) that may be used for HCP with untreated TB infection or anytime a HCP is tested for TB after rent.

*Annual TB testing using an IGRA or TST and symptom screening may be considered for HCP with significant occupational risk, such as pulmonologists or respiratory therapists in high risk settings, or in settings where TB exposures have occurred in the past (i.east. emergency departments). This decision should be adult by the healthcare staff responsible for infection command and may be done in collaboration with your local health department.

If annual testing with a TST or blood test is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?

We recommend that facilities consider the local epidemiology of TB in their county (PDF), including adventure factors for TB (PDF) [CDC] in their staff, and whatever past TB exposures in the facility when deciding to implement periodic TB screening afterward baseline testing. The purpose of screening for TB using a signs and symptoms assessment questionnaire is to ensure agile TB is identified early on. Anyone with symptoms of TB should be referred for medical evaluation.

How should I screen my employee for TB upon rent if they say they already take a positive TB skin or blood test?

HCP with documentation of a previous positive TST or IGRA result, or documentation confirming completion of treatment for TB infection or disease, should be screened for TB in the post-obit way:

Consummate a TB signs and symptoms assessment.
Have a baseline chest x-ray (CXR) performed (unless a recent copy is available).

HCP with documentation of a previous positive TST or IGRA outcome should non be re-tested with a TST or IGRA.

After the baseline screening, serial or routine CXRs are not recommended; however, persons exhibiting symptoms of TB disease require a CXR regardless of history.

HCP without documentation of the previous examination result should undergo baseline screening with a two-step TST or an IGRA. An private risk assessment (PDF) and signs and symptoms screening assessment should also be completed (refer to Baseline Tuberculosis Assessment for Health Care Personnel (PDF)). Copies of the TB screening results and responses to the symptom screen and individual hazard assessment should be kept past the employee as documentation in instance of future screenings.

Tin a new hire's documented negative tuberculin skin test (TST) result be used in performing a baseline two-step TST?

Yes, a new hire's documentation of a negative TST result can be recorded as step one of the two-step TST when administered any fourth dimension during the previous 12 months, if the result was documented in millimeters (mm). The TST administered at hire volition be recorded as step 2 of the two-stride TST.

For more details, refer to the Guidelines for Preventing the Transmission of M. TB in Health-Intendance Setting, 2005 (PDF) [CDC] TB Infection-Control Surveillance.

What do I demand to know if my employee has received a BCG vaccine?

The IGRA and TST are not contraindicated for persons who have been vaccinated with Bacillus Calmette–Guérin (BCG). The effectiveness of BCG wanes overtime but it may cause a false-positive reaction to the TST, which may complicate decisions nearly diagnosing TB infection and prescribing treatment. IGRAs use M. tuberculosis specific antigens that do not cross react with BCG, and therefore, exercise not cause false positive reactions in BCG recipients. This means an IGRA test is preferred for BCG vaccinated individuals. More data can be found on the CDC website.

Are routine or annual CXRs all the same recommended?

No, chest x-rays should non be performed routinely or annually for persons with a positive IGRA or TST. Health intendance personnel, patients or institutional residents with a baseline positive or newly positive IGRA or TST consequence who are likely to be infected with TB should receive ane breast radiograph to exclude a diagnosis of TB disease. Repeat chest x-rays are not needed unless signs or symptoms of TB develop, or a clinician recommends a repeat breast radiograph, or after a new exposure to TB.

Wellness care personnel who have a previously positive IGRA or TST effect and who change jobs should bear documentation of the results of their IGRA or TST, chest radiograph and documentation of treatment history for TB infection, if applicable, to their new employer.

Tin can my employee with a positive TB skin or blood test return to work?

HCP who are likely * infected with TB based on a positive TST or IGRA consequence and individual risk, should be referred for a CXR and medical evaluation to rule out agile TB prior to returning to piece of work. If a diagnosis of TB infection is made, HCP may return to piece of work, as TB infection is not contagious. They should exist educated on handling options for TB infection to reduce their chance of developing TB affliction.

HCP who are asymptomatic, unlikely* to exist infected with TB, and who are at low risk for progression to TB illness based on individual run a risk, should have a 2nd test (either an IGRA or a TST) if their first test is positive. Only when the second exam is positive in depression risk individuals is TB infection considered an authentic diagnosis (PDF).

What further actions do I demand to have when HCP are diagnosed with TB infection or TB disease?

TB infection, TB disease, and suspicion of TB disease are all reportable to your local health department. See How do I written report TB? for reporting requirements.

Should HCP be treated for TB infection?

Treatment for TB infection should be considered in all persons to prevent the progression to TB disease. This decision should be fabricated between the HCP and their wellness care provider.

When facilities screen for TB, DSHS recommends that an annual education component is included in the screening plan. Instruction can include information on signs and symptoms of TB, the difference betwixt TB infection and affliction, TB risk factors, and the risks for developing TB disease if non treated.

Have the updated 2019 guidelines for screening HCP for TB changed the demand for a facility gamble cess?

No, facility risk assessments are nonetheless recommended. The results of the assessment are no longer used to determine frequency of TB screening merely are useful in documenting infection control in facilities. Refer to the CDC website for more details on the apply of the risk cess and updates to the 2019 guidelines.

Does DSHS have a sample form that health intendance facilities may employ to certificate TB screening, testing, and instruction?

Yeah. DSHS has developed the post-obit forms that facilities may employ or modify to fit their need.

Baseline Tuberculosis Cess for Health Intendance Personnel (PDF). It is intended for use in health intendance facilities when assessing employees for TB upon hire.
Afterwards Hire Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for use in health care facilities when assessing employees for TB any time after baseline screening.
Tuberculosis Screening Results and Work Clearance for Wellness Care Personnel (PDF). Information technology allows facilities to document results of baseline and after hire screening including the recommended annual education.

These forms are non required by DSHS just may be used to guide and document facility screening practices, as they align with DSHS and CDC recommendations.

Where can I detect more than information regarding screening health care personnel for TB?

Refer to the Centers for Disease Control and Prevention (CDC) website for more than information.

TB and COVID-nineteen

Do COVID-nineteen and TB share similar symptoms?

Yes, TB and COVID-19 have some similar symptoms such as a coughing or a fever. Only a licensed healthcare provider tin determine the cause of symptoms and further testing may be needed. For healthcare providers, information technology is important to "Recollect TB" when symptoms and take a chance factors for TB are present. See Tuberculosis and COVID-19 Know the Departure (PDF) for details.

Are at that place recommendations to filibuster TB screening in persons recently vaccinated against COVID-xix?

No, TB screening should not exist delayed for people with take chances factors for TB who have been vaccinated against COVID-nineteen. The Centers for Disease Control and Prevention (CDC) has data most TB screening practices and the COVID-19 vaccine.

It is recommended that those in charge of TB screening visit the CDC website periodically for any updates regarding TB screening practices. When considering the bear on of TB in your area, please consult with your regional or local health department (R/LHD). Report suspected and confirmed TB infections to your R/LHD.

General Reporting Requirements

How practise I study tuberculosis screening results?

Both TB infection and TB disease are Notifiable Conditions reportable to the local or regional health section TB Programs. Reporting details tin can be found on the DSHS website, which include reporting forms.

Tuberculosis Infection- Reportable inside ane (i) week to the local or regional health department. A diagnosis of a latent TB infection is Not complete until the following criteria have been met:

Positive skin exam with results written in millimeters and date read, or positive IGRA blood exam results; and
Documentation that patient has no current signs or symptoms of active tuberculosis disease; and
CXR results that are read as normal, or not consistent with TB; and
There is no suspicion of Active TB disease

TB Disease or Suspicion of TB Disease- Reportable within 1 (1) working day.

Recommendations for TB Screening of Adults and Children in Various Settings

Are in that location general recommendations nigh which adults should and should non exist screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of adults in Texas, depending on identified TB risk factors. Please refer to information in Tuberculosis Screening Recommendations for Adults in Diverse Settings (TB-1002) (PDF).

Are at that place general recommendations about which children should and should not exist screened for TB in Texas, and how to screen them?

Yeah, the DSHS TB Unit has recommendations for TB screening of children in Texas, depending on identified TB run a risk factors. Please refer to information in Tuberculosis Screening Recommendations for Children in Various Settings (TB-1003) (PDF).

What are the screening requirements for TB testing in facilities that provide care to children?

Facilities with a let or license from Texas Health and Human Services (HHS) to provide care to children volition abide by the capacity that utilize to each type of facility in the Texas Authoritative Code (TAC) Championship 26, Part 1.

The Minimum Standards folio on the HHS website contains links to the standards related to daycare facilities, 24-60 minutes residential care, and child-placing agencies. These links are located at the bottom of the folio.

Any facilities that provide care to children and are not listed in a higher place should start review the Texas Authoritative Code for any statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB programme may assist in developing screening, testing, and handling plans.

What are the screening requirements for TB testing in adult care centers such as assisted living facilities?

Screening requirements for adults working in these facilities are outlined in the Long-Term Care Regulatory Provider Letter of the alphabet (PDF) :

Assisted Living Facility
Day Activeness and Health Services Facility
Intermediate Care Facility for Individuals with an Intellectual Disability or Related Conditions
Abode and Customs Support Services Agency
Nursing Facility, and
Prescribed Pediatric Extended Intendance Center

Facilities licensed by HHS for developed care in Type A and Type B Assisted Living Facilities will bide by Texas Administrative Code (TAC) Championship 26 Part 1 Chapter 553 Subchapter Due east Rule §553.261B. TB requirements are summarized below; however, each facility should review the TAC for specific details:

Facilities must develop written policies for the control of catching diseases in employees and clients, including TB screening and the provision of a safe and sanitary environment for clients and their families.
Screen employees for TB within two weeks of employment.
After hire, facilities must follow CDC guidance in Tuberculosis Screening, Testing, and Treatment of U.S. Health Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. See FAQs for Health Intendance Professionals.
Facilities must screen residents for TB upon admission and later exposure to TB.
Any facilities that provide care to adults and are not listed above review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing bureau. Collaboration with a local or regional TB program may assist in developing screening, testing, and treatment plans.

For Schools

Do all employees in Texas schools even so demand a tuberculin skin test?

At that place is no statewide requirement for teachers or other schoolhouse employees to take a tuberculin skin test or TB blood examination. The Centers for Disease Control and Prevention (CDC) and DSHS discourage the use of the tuberculin pare testing or IGRA blood test for persons who have no risk factors for TB exposure.

However, anyone with signs or symptoms of TB should be considered for medical evaluation.

Specifications for employee or volunteer TB screening may be required by a licensing, credentialing, or insurance policy, or past the school district's regulations and requirements. Each school should defer to their ain policy.

Do all new students in Texas schools withal need a tuberculin skin examination?

No. A tuberculosis questionnaire has been developed past Texas Department of Land Wellness Services to identify children at loftier gamble for TB infection. Refer to the list of counties with a loftier incidence of TB (PDF) where use of the questionnaire is recommended prior to inbound school. As resources permit, school districts in other counties may use the TB questionnaire to place children who should receive a TB peel test prior to school entry.

Children who have a positive reaction to the TB pare test but no symptoms of TB affliction shouldNOT exist kept out of school while they are being evaluated for treatment of TB infection.

The American University of Pediatrics (AAP) recommends that physicians routinely assess a child's risk of TB exposure with a questionnaire and offer tuberculin skin testing but to at-risk children. The AAP does not recommend routine tuberculin pare testing of children with no TB risk factors for schoolhouse entry, day care attendance, WIC eligibility, or camp omnipresence.

A tuberculin skin exam may exist applied on the same 24-hour interval as routine immunizations. The skin exam will need to be read 48-72 hours afterward. If a skin test is not placed on or before the day of a live virus immunization such as measles-mumps-rubella (MMR), then the skin examination should be postponed at least six weeks.

For more than information about TB screening for children in schoolhouse settings visit the following links:

Recommendations for TB Screening of Schoolhouse Aged Children (PDF)
Tuberculosis Questionnaire in English (DOC)
Tuberculosis Questionnaire (en Español) (DOC)

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

The law (Chapter 89 of the Texas Wellness & Condom Lawmaking) in Texas requires county correctional facilities that see whatsoever i of three criteria to screen all inmates for TB by the seventh twenty-four hour period of incarceration and annually thereafter, and to screen all employees and volunteers both pre-employment and annually thereafter.

The three criteria are every bit follows:

a capacity of 100 or more beds,
housing inmates transferred from a county that has a jail with a capacity of 100 or more than beds, or
housing inmates from another state.

The police force as well requires all correctional facilities in the state, including youth detention facilities, regardless of whether they meet the criteria stated above, to report to the Texas Section of State Health Services, Infectious disease Intervention and Control Branch, the release of inmates being treated for TB and so that the Section can adjust for continuity of care.

Other Resources

What are other recommended sites where I tin can find information about tuberculosis?

Centers for Affliction Control and Prevention:

Bones TB Facts
Tuberculosis Fact Sheet
Tuberculosis Fact Sail (PDF) Courtesy of the CDC

HIPAA:

Frequently asked questions well-nigh HIPAA Privacy Rule

Medical Consultation:

TB Medical Consultation Procedure

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Source: https://www.dshs.texas.gov/disease/tb/faq.shtm