• Diagnostic evaluation of TB suspects
• Treatment of LTBI and TB disease in adults, children, and adolescents
• 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
• Management of patients with significant coexisting conditions: HIV, renal insufficiency, hepatic disease, pregnancy, etc.
• 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

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 COE's
4. Contacting the HNTC directly via telephone. Calls preferably come to either a dedicated toll-free warm-line telephone number in San Antonio (800-TEX-LUNG or 800-839-5864) or to a nurse consultant: Catalina Navarro (210-531-4569); Iris Barrera (210-531-4580); Marybel Monreal (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 (barbara.seaworth@uthct.edu, lisa.armitige@uthct.edu) or the nurse consultants (catalina.navarro@uthct.edu, iris.barrera@uthct.edu, or marybel.monreal@uthct.edu), directly via email. Email addresses are provided on the HNTC website and in promotional literature.
6. *NEW* Send an email to the nursing team at heartlandconsultation@uthct.edu

The HNTC consultant line is a warm-line that is staffed during business hours and is a non-emergency line. If there is an urgent medical issue and you need to reach a consultant outside of business hours, please e-mail a medical consultant (e-mail addresses noted above). If an attempt to reach an HNTC Medical Consultant is not successful or an immediate response is needed, please refer to emergency support within your community or state.

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 left after 4:00 pm will be returned by the medical or nurse consultant within one business day.

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 signed by the Medical Consultant, the Administrative Specialist makes distribution by faxing or scanning 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 (this is also done via email prior to medical consultant signature).
• 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 applicable 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.