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This version of the form is not currently in use and is provided for reference only. Download this version of
State Form 14058
for the current year.
State Form 14058 Report of Tuberculosis - Indiana
What Is State Form 14058?
This is a legal form that was released by the Indiana State Department of Health - a government authority operating within Indiana. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form 14058?
A: Form 14058 is the Report of Tuberculosis in Indiana.
Q: Who needs to file Form 14058?
A: Medical professionals and facilities are required to file Form 14058 when they diagnose or treat a patient with tuberculosis in Indiana.
Q: What information is required on Form 14058?
A: Form 14058 requires information about the patient's demographics, medical history, diagnosis, treatment, and contacts.
Q: Why is Form 14058 important?
A: Form 14058 helps the Indiana State Department of Health track and prevent the spread of tuberculosis in the state.
Q: When should Form 14058 be filed?
A: Form 14058 should be filed within 72 hours of diagnosing or treating a patient with tuberculosis in Indiana.
Q: Are there any penalties for not filing Form 14058?
A: Failure to file Form 14058 may result in penalties imposed by the Indiana State Department of Health.
Q: Are there any fees for filing Form 14058?
A: There are no fees associated with filing Form 14058 in Indiana.
Q: Can I request a copy of Form 14058?
A: Yes, you can request a copy of Form 14058 from the Indiana State Department of Health.
Form Details:
- Released on October 1, 2017;
- The latest edition provided by the Indiana State Department of Health;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a fillable version of State Form 14058 by clicking the link below or browse more documents and templates provided by the Indiana State Department of Health.
Download State Form 14058 Report of Tuberculosis - Indiana
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