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Memorandum of Understanding (MOU) template between Local Health Department and Homeless Shelter
(2014, San Francisco Department of Health TB Control)
TOOLS AND TEMPLATES
This modifiable template can be used as a starting point for
creating MOUs between healthcare providers and shelter staff to
identify the roles and responsibilities of each in the fight against
tuberculosis.
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Memorandum of Understanding 2 (MOU) between Local Health Department and Community Health Centers
(2014, San Francisco Department of Health TB Control)
TOOLS AND TEMPLATES
This modifiable template can be used as a starting point for creating MOUs between healthcare providers and community health centers to identify the roles and responsibilities of each in the fight against tuberculosis.
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Direct Observed Therapy Agreement
(2012, San Francisco Department of Health)
TOOLS AND TEMPLATES
This modifiable template can be used by local programs to define roles and responsibilities of clients and LHDs who are participating in a DOT program for TB.
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Housing Incentive Program Participation Agreement
(2012, Virginia Department of Health)
TOOLS AND TEMPLATES
Excerpted from Guidebook For The Homeless Incentive And Prevention (HIP) Program, this modifiable template can be used by local programs who are able to provide housing for their TB patients who aree experiencing homelessness.
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Temporary TB Clearance Form Template
(2012, San Francisco Department of Health)
TOOLS AND TEMPLATES
This modifiable template can be used by local programs to provide clients with temporary clearance to enter a shelter or apply for a job pending their test results.
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Medical Facility Communication Sheet
(2011, San Francisco Department of Public Health)
TOOLS AND TEMPLATES
This form can be used or modified by Healthcare providers when transferring TB patients from a medical facility into a shelter setting. It allows medical staff to communicate to shelter staff the patient’s condition, medical needs, appointments, medications, and whether or not to isolate the patient from the general population.
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THINK TB Poster for Healthcare Providers
(2005, Maine DHHS, Bureau of Health’s Division of Disease Control)
TOOLS AND TEMPLATES
A one-page poster that can be placed in healthcare
facilities where staff may be less familiar with tuberculosis. It
identifies risk factors that should be considered when evaluating a
patient for TB.
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