Hospital Discharge Approval Request Form TB 354
This document is a crucial form for obtaining approval before discharging TB patients from hospitals in NYC. It ensures that all necessary patient information is collected for proper follow-up care. Health care providers must complete this form accurately and submit it to the NYC Department of Health and Mental Hygiene.
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How do I fill this out?
Filling out the Hospital Discharge Approval Request Form is a straightforward process. Start by gathering all relevant patient information and follow the outlined sections carefully. Ensure that you provide clear and accurate details for timely approval.

How to fill out the Hospital Discharge Approval Request Form TB 354?
1
Gather patient contact and discharge information.
2
Complete follow-up appointment details.
3
Report laboratory results accurately.
4
Fill in treatment information including TB medications.
5
Review and submit the form to the required department.
Who needs the Hospital Discharge Approval Request Form TB 354?
1
Healthcare providers to report TB cases accurately.
2
Hospitals to comply with NYC health regulations.
3
Patients requiring follow-up care after discharge.
4
Facility administrators managing patient records.
5
Public health officials tracking TB treatment progress.
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What are the instructions for submitting this form?
To submit the Hospital Discharge Approval Request Form, complete all sections accurately and fax it to the Bureau of TB Control at 844-713-0557. Ensure your submission occurs at least 72 hours prior to the planned discharge date for timely approval. Always keep a copy for your records and follow up if you do not receive confirmation of approval.
What are the important dates for this form in 2024 and 2025?
Key dates for submitting the TB 354 form will vary by patient discharge plans; however, healthcare providers should aim to submit at least 72 hours in advance of the planned discharge. For 2024 and 2025, check specific hospital discharge dates to ensure compliance with New York City health regulations.

What is the purpose of this form?
The Hospital Discharge Approval Request Form is designed to ensure that tuberculosis patients are properly managed before their discharge from healthcare facilities. It collects critical data to facilitate follow-up care and compliance with public health laws. This process safeguards both the patient and community health by confirming that all necessary protocols are followed.

Tell me about this form and its components and fields line-by-line.

- 1. Patient Contact Information: Details regarding the patient's identity and emergency contact.
- 2. Discharge Information: Information about the discharging facility and discharge plans.
- 3. Patient Follow-Up Appointment: Scheduling information for the patient's follow-up care.
- 4. Laboratory Results: Recent test results critical to patient health.
- 5. Treatment Information: Details of the patient's TB treatment regimen.
What happens if I fail to submit this form?
Failure to submit the Hospital Discharge Approval Request Form can result in delays in patient discharge. Additionally, it may lead to non-compliance with health regulations, affecting both patient care and facility liability.
- Delayed Discharge: Patients may have to remain in the hospital longer than necessary.
- Legal Implications: Non-compliance could result in penalties or legal action against the healthcare provider.
- Compromised Patient Care: Discharges without proper oversight could risk patient health and community safety.
How do I know when to use this form?

- 1. Prior to Hospital Discharge: Used to secure necessary approvals before releasing infectious patients.
- 2. For Compliance with Health Regulations: Ensures adherence to health codes set by city regulations.
- 3. To Document Patient Follow-Up: Facilitates further treatment and monitoring post-discharge.
Frequently Asked Questions
How do I fill out the Hospital Discharge Approval Request Form?
Begin by completing each section with accurate patient information, ensuring all necessary details are provided.
What is the purpose of this form?
The form is used to get approval from the NYC Department of Health before discharging patients diagnosed with contagious TB.
Can I edit this PDF online?
Yes, you can easily edit the PDF on PrintFriendly before downloading.
Where do I send this form after filling it out?
Fax the completed form to 844-713-0557 for approval.
What happens if I submit this form late?
Submitting the form late could delay the discharge process for the TB patient.
Is there a cost associated with submitting this form?
There is no fee for submitting the Hospital Discharge Approval Request Form.
Can I download the filled form?
Yes, after editing, you can download the filled form to your device.
What if I need help while filling out the form?
You can contact the Bureau of TB Control for assistance while completing the form.
Are follow-up appointments mandatory?
Yes, it's vital to schedule follow-up appointments for the patient's care post-discharge.
Is this form required for all TB patients?
The form is specifically required for infectious TB patients being discharged from a health care facility.
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