Plan for Housing Homeless Tuberculosis Patients
Health Jurisdiction:
Projected Housing Rate
The 2015 California objective for the proportion of TB cases that complete therapy in less than 12 months is 88%. To meet this goal, the (insert name of jurisdiction) will attempt to house at least percent of the homeless* tuberculosis (TB) patients and suspects identified in its jurisdiction each year.
Projected Completion of Therapy Rate
Of the patients housed by this program, percent will complete an appropriate course of anti-tuberculosis therapy in less than 12 months.
DOT Requirement
All patients housed by this program will be placed and maintained on directly observed therapy (DOT).
Average Number of TB Cases and Suspects Annually
The average number of TB cases and suspects identified as homeless at any time during the period of their examination and/or treatment in this health jurisdiction each year for the last three years is: Confirmed TB cases Suspects .
Plan for Housing Non-Infectious TB Patients
Noninfectious patients will be housed at the following location(s)
(Repeat for each site used):
Name of Site:
Address of Site:
Type of Site: Hotel Adult Residential Facility
Other (specify):
Projected Cost of Housing (including food) $ per day
Plan for Housing Infectious TB Patients
Infectious patients will be housed in accordance with the “Policy for Housing Patients with Confirmed or Suspected Tuberculosis Who are Considered Infectious” (http://www.cdph.ca.gov/programs/tb/Documents/TBCB-SPM-CD-Policy-for-Housing-Patients.doc) at the following locations:
Name of Site:
Address of Site:
Type of Site: Hotel Adult Residential Facility
Other (specify):
Projected Cost of Housing (including food) $ per day
*For a definition of homelessness, please see the Standards and Procedures Manual at: http://www.cdph.ca.gov/programs/tb/Documents/TBCB-SPM-Manual.pdf
Plan for Providing for Concomitant Needs:
The concomitant needs of homeless TB patients (e.g., treatment for substance abuse and/or mental illness) housed by this program will be addressed as follows:
Food will be provided by the following means:
Sources of Non-CDPH TBCB Funding for Housing TB Patients
At present, this health jurisdiction receives funding for housing homeless TB patients and/or suspects from the following agencies:
Agency Amount Received per Fiscal Year (FY)
Past FY: Current FY: Next FY:
$ $ $
$ $ $
$ $ $
$ $ $
Signed Date
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Telephone
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