0920-1186 Telephone Script for Clinician/Foreign Health Authority

Centers for Disease Control and Prevention

OMB Approved

Control No 0920-XXXX

Exp Date: XX/XX/XXXX

Division of Global Migration and Quarantine

Telephone script for clinician/foreign health authority referral follow-up.

Hello. My name is [SAY NAME] and I am calling from the Centers for Disease Control and Prevention in Atlanta, Georgia, USA. Through the CureTB program, an individual by the name of [SAY INDIVIDUAL’S NAME] was referred to you to continue and complete their treatment for tuberculosis. I am calling to find out how the individual is progressing. I have a few questions for you.

1) Is patient still on treatment?  Yes or No

2) If yes, what medications?

3) What is anticipated data of treatment completion?

4) If not, what is the final outcome? 

Standard international outcomes:

• Lost

• Abandoned

• Died

• Stopped for medical reasons

• Completed treatment 

Thank you for your time. If you have any questions, please do not hesitate to contact me.

[PROVIDE EMAIL ADDRESS].

Good day.

Public reporting burden of this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA 0920-XXXX