Medical Consultation

Medical and nursing consultation and technical assistance with various aspects of TB control are available at no cost to physicians, nurses and other health care professionals in the thirteen states that comprise the Heartland Region.

HNTC Regional Medical Consultation Services Plan

Download the current plan (PDF4/3/2014).

View the State-Specific Consultation Processes (Last Updated: 1/21/2014).

Common Reasons for Consultation

  • Diagnostic evaluation of TB suspects
  • Treatment of LTBI and TB disease
  • Treatment of drug resistant TB cases, including MDR and XDR
  • Diagnostic and treatment approaches to cases of delayed bacteriologic, clinical and/or radiographic response to therapy
  • Treatment failure
  • Relapse of TB disease
  • Adverse drug effects: GI upset, rash, hepatitis, other
  • Diagnosis and treatment of LTBI and TB disease in children and adolescents
  • TB in the setting of HIV infection
  • Management of patients with significant coexisting conditions: renal insufficiency, hepatic disease, pregnancy, other
  • Non adherence with treatment
  • Investigation, evaluation and treatment of contacts to an infectious TB case
  • Responding to a tuberculosis outbreak
  • Infection control measures to reduce transmission of tuberculosis
  • Nurse case management

How to Access Our Services

Health care providers may access consultation and technical assistance services by one of several methods:

1. Referral from the existing medical consultation process within each state

2. Referral from the CDC Call Center

3. Referral from other RTMCC's

4. Contacting the HNTC directly via telephone. Calls preferably come to either a dedicated toll-free telephone number in San Antonio (800-TEX-LUNG or 800-839-5864) or to a Nurse Consultant: Catalina Navarro, RN, BSN (210-531-4569) or Debbie Onofre, RN, BSN (210-531-4539). Clinicians may also contact one of the HNTC Medical Consultants directly. Phone numbers are provided on the HNTC website, as well as promotional literature.

5. Contacting the Medical Consultants (, (, or the Nurse Consultants (, or, directly via email. Email addresses are provided on the HNTC website and in promotional literature.

The consultation line is staffed Monday – Friday, from 8:00 AM until 5:00 PM, Central Time. After business hours, voice mail service is available. Voice mail messages will be returned within one business day by the Medical Consultant or a Nurse Consultant.


Once the Medical Consultant has contacted the requestor, the HNTC response to the inquiry is determined by the nature of the request and the stated preference of the requestor.  Recommendations may take the form of a written consult, an email reply or telephone consultation:

  1. Written consult
    • Written responses will be prepared within three to five business days following the date of the initial request (within three days for at least 80% of requests)
    • Once the consult is dictated by the Medical Consultant, the Administrative Specialist produces a written draft and returns it to the Medical Consultant for review. Following the Medical Consultant’s review, the consult is prepared by the Administrative Specialist in final form for signature.
    • Once the consult is signed by the Medical Consultant, the Administrative Specialist makes distribution by faxing copies to, as appropriate, the requestor, the treating physician or other health care provider, the local health department and the TB Controller or other appropriate public health authority of that state.  The original consult is mailed to the requestor (Note: see “End-User Satisfaction” described below).  A copy of the consult is retained for the patient’s consult record, and a copy is forwarded to the Nurse Consultant for review.
    • If a case is judged by the Medical Consultant to be of significant public health importance, e.g., an extensive contact investigation surrounding a case of multi-drug resistant TB, he/she may elect to communicate directly with the State TB Control Program to facilitate the public health response.

  2. Email reply:  The Medical Consultant incorporates the recommendations in an email to the requestor.  A copy of the email is sent to the TB Controller or other appropriate public health authority of that state and to the Nurse Consultant for review and eventual inclusion in the patient’s consult record.

  3. Telephone consultation:  The Medical Consultant will summarize the discussion and recommendations on the telephone consult worksheet. A copy of the worksheet is forwarded to the Nurse Consultant for review and eventual inclusion in the patient’s consult record.  If indicated, an email will be sent to the TB Controller or other appropriate public health authority of that state to inform them of the recommendations made.