product order form alysi a wayne - heartland …product order form instructions: please complete...

Number requested: (available online only)

of 2 Revised 1/16/2020

Product Order Form INSTRUCTIONS: Please complete both pages and send to:

Alysi a Wayne Heartland National TB Center · 2303 SE Military Drive · San Antonio, TX 78223

PH: (800) 839-5 864 FAX: (210) 531-4590 [email protected]

A.) TB in the Community: Educational Flipchart facilitating work in the border regions; each chart is in English and Spanish.

Number requested: ________________ (maximum order is 2; contents contain both English and Spanish sections)

B.) BMI Chart: Impact of poor nutrition on TB relapse – 6.33" W x 13.58" H (tri-fold)


C.) Impacto de la Mala Nutrición en la Recaída de TB (BMI Chart SPANISH) – 6.33 “ W x 13.58” H (tri-fold)


D.) Beyond Diversity: A journey to cultural proficiency – a facilitator guide used to build internal capacity within TB programs.

Number requested: _________________ (maximum order is 10)

E.) Calipers for measuring TST reactions


F.) Clinicians Guide to the TB Laboratory

Number requested: _________________(maximum order is 2)

G.) Case Studies in Tuberculosis: Nurse Case Managment Training Tools for Patient Success - a collection of nurse case studies and

accompanying tools. (CNE Credit Available)


H.) Characteristics of Second-Line Drugs for MDR-TB


I.) Evaluation of a Pregnant Patient at Risk for TB - 1 page flow diagram for clinicans and healthcare providers.

Number requested: (resource unavailable)

J.) Guidelines for Home and Hospital Isolation of Infectious Tuberculosis Patients


K.) Injectable Administration – 2 page teaching sheet for clinicians and healthcare providers covering Amikacin, Capreomycin OR Streptomycin

Amikacin requested: _____________ Capreomycin requested: _____________ Streptomycin requested: _____________

L.) Limiting Liver Toxicity in the HIV-Positive Patient with Latent Tuberculosis Infection


M.) Management of the Active TB Patient at Risk of Hepatotoxicity – 1 page flow diagram for clinicians and healthcare providers.


N.) Mental Health Assessment Tool

Number requested: ________________(maximum order is 10)

O.) MDR TB Care Plan – 1 page diagram for clinicians and healthcare providers.


P.) Plan de Cuidado para el Paciente con TB Multifármaco Resistente (MDR TB Care Plan in SPANISH)


Q.) Model Tuberculosis Prevention Program for College Campuses – manual for local or college health care healthcare providers.

mailto:[email protected]

R.) Pediatric TB Radiology for Clinicians – shows and describes examples of radiographic abnormalities common in pediatric tuberculosis, emphasizing pulmonary, lymphatic and meningeal disease.


S.) Revised Tuberculosis Treatment Guidelines (2003) – 1 page poster for clinicians or healthcare providers.


T.) Rifamycins and Anti-Diabetic Agents: Drug-Drug Interactions - 2-sided diagram for clinicians and healthcare providers that describes drug-drug interactions of Rifamycins and anti-diabetic agents.

Number requested: ________________ (maximum order is 25)

U.) Rifamycins and Cardiovascular Agents: Drug-Drug Interactions - 2-sided diagram for clinicians and healthcare providers that describes drug-drug interactions of Rifamycins and cardiovascular agents.


V.) Rifamycins and Psychotropic Drugs: Drug-Drug Interactions - 2-sided diagram for clinicians and healthcare providers that describes drug-drug interactions of Rifamycins and psychotropic drugs.


W.) TB Core Reference Set for Clinicians – CD-ROM with comprehensive list of reference materials.

Number requested: (resource under review)

X.) TB at a Glance: A reference for practitioners on basic tuberculosis information - pocket size booklet that provides basic information on the

diagnosis and treatment of TB.


Y.) Tuberculosis Adverse Drug Events – 4 x 5 pocket guide for healthcare providers.

Number requested: (product under review; resource is available online)

Z.) Tuberculosis Medication Drug and Food Interactions – 4 x 5 pocket guide for healthcare providers.

Number requested: (product under review; resource is available online)

AA.) Tuberculosis Treatment Guidelines (2016) - 4 x 5 pocket guide for healthcare providers.


BB.) Tumor Necrosis Factor-Alpha (TNF-Alpha) Antagonists and the Increased Risk of Tuberculosis


CC.) TB Testing in Children Number requested: (resource available online only)

Mailing and Contact Information Name:

Discipline (RN, BSN, etc.):

Job Title:

Agency:

Address 1, Address 2:

City, State/Province, Zip:

Country:

Phone: ( ) — Ext.

Fax: ( ) —

Email: Additional Notes: If requesting more than maximum single order, please provide justification.

QUESTIONS ABOUT HNTC PRODUCTS? NEED MORE THAN THE MAXIMUM? Please contact Alysia Wayne at 1-800-839-5864 or [email protected]

If needed by a specific date, please contact Alysia.

of 2 Revised 1/16/2020

mailto:[email protected]

product order form alysi a wayne - heartland …product order form instructions: please complete...

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