Tuberculosis Clinic Referrals Criteria

Guidelines for Referrals to the San Francisco TB Clinic

To refer patients to the San Francisco TB Clinic, please complete the interagency TB47 referral form. We are not able to see patients without a referral.

We do not accept referrals for:

• General TB screening
• Employment or school TB screening
• Asymptomatic patients with prior history of completing LTBI treatment
• Asymptomatic patients with a normal chest x-ray, no special medical condition, and a positive TB skin test (TST) or TB interferon gamma release assay (IGRA, commercially available as QuantiFERON-TB Gold or T-SPOT.TB)

Referred patients must be residents of the City and County of San Francisco and have one or more of the following criteria for referral:

• Patients without a medical home requiring program or shelter clearance
• Patients with suspected or confirmed active TB disease. These patients must be reported directly to the San Francisco TB Clinic. This includes:
  • Patients with symptoms consistent with active TB disease
  • Patients with abnormal chest x-ray consistent with active TB disease
• Complicated latent tuberculosis infection (LTBI) defined as a positive TB test (skin test or blood test) and chest Xray not consistent with active TB and one high risk factor for progression or treatment complexity. (note: TST of 5 mm or more is considered positive among individuals at high-risk)
  • Abnormal chest Xray consistent with old, healed TB
  • Immunosuppression: HIV infection, transplant recipient, treatment with TNF-alpha antagonist, steroids (equivalent of prednisone ≥15 mg/day for ≥1 month) or other immunosuppressive medication
  • End-stage renal disease on hemodialysis
  • Children under 5 years of age (0-4 years old)
  • Contact to an active case or new TB test conversion to positive (previously documented negative test)
  • Intolerant of two or more LTBI regimens or underlying liver disease with abnormal LFTs
  • On medication-assisted treatment for substance use disorder
  • For other complications or categories not listed, please call the clinic to discuss the referral & include documentation of your discussion with the referral

Referral from Civil Surgeon for Patients with Abnormal Chest X-ray or HIV

• LTBI Referral (Specific to Civil Surgeons)