TUBERCULOSIS RECORD SYSTEMS | PAGE 
1. mat is a State Central Record System for Tuberculosis? 4 
2. Why is a State Central Record System needed? 7 
3. How large a task is the installation el a State Central 
Record System? 13 
4. What equipment is needed? IE 
5. How can information be interchanged? 22 
6. Hew are initial eases selected? 29 
7. Haw is a State Central Record System installed and maintained? 36 
8. Now is a Local Register installed? 55 
9. Now is a Local Register maintained? 57 
10. What statistical data will the Central Record System provide? 70 
TABLE 
OF 
CONTENTS State Central Case Record Systems 
and 
Local Case Registers 
for Tuberculosis 
Published by the N. C. State Board of Health 
in Cooperation with the Tuberculosis Control Division, 
United States Public Health Service 
1947 Preface... 
Almost every State in the Union now has a tuberculosis control program. In response to 
urgent requests from these States, this manual has been prepared to assist in the establish- 
ment of efficient record systems. If tuberculosis control programs are to be fully effective, 
accurate and complete record systems must be instituted and maintained as soon as possible. 
This manual presents a proved and tried method of keeping such records, and it is presented 
in the hope that it will assist in the development of uniform and widely used systems 
through the country. 
Simple and efficient tuberculosis record systems that are planned to meet State and local 
needs are fundamental to good follow-up procedures. Indeed, mass casefinding is of little 
value if all cases found are not followed, and the record system is the chief tool in such 
enterprise. State and local systems facilitate a maximum utilization of limited clinical, lab- 
oratory, and field nursing services. To correlate all phases of tuberculosis control, to bring 
about an equitable distribution of professional services, there exists an urgent need for com- 
prehensive record systems, based upon defined requirements. 
With the rapid expansion of local, State, and Federal activities, registers and record sys- 
tems have assumed additional significance. In a State with an established tuberculosis control 
program, a case record system is essential for administration, current inventory of the case 
load, interval evaluation of the effectiveness of control activities, and for a realistic knowledge 
of the extent of the problem. 
This manual employs throughout its pages a term which is new to statistical nomencla- 
ture. In order to differentiate between the State records and the local records, the term, 
"State Central Record System,” has been used to designate the State records, while the 
familiar term, "registers,” has been used for local record systems. These terms are clearly 
defined in the text. 
The work in this manual is based on extensive field studies, particularly in the States of 
Oregon and Kansas. Research was conducted by the Field Studies Section, Tuberculosis 
Control Division, U. S. Public Health Service. Special acknowledgment is made to Dr. J. 
Yerushalmy, who supervised this project, to Miss Mary Burke, Mr. Deward Waggoner, to Mr. 
Herbert Sauer, Miss Marcella Siegel and to Mr. Maurice Eysenburg. 
HERMAN E. HILLEBOE, 
Assistant Surgeon General 
Associate Chief 
Bureau of State Services 
FRANCIS J. WEBER 
Medical Director 
Chief, Tuberculosis Control Division n local health departments it has long been recog- 
nized that simple and efficient tuberculosis case regis- 
ters are indispensable tools for case holding, case 
management, evaluation of activities and definition 
of local problems. In State health departments, with 
the expansion of tuberculosis control activities, it has 
become apparent that there is need also for central 
State case record systems for program planning, 
supervision and evaluation. 
State and local case record systems will, by their 
very nature, be interdependent, each contributing 
significantly to the success of the other. Many func- 
tions will be common to both, yet each system will 
serve distinct purposes. It is, therefore, desirable to 
use a different designation for each system. For pur- 
poses of clarity the local system will be called a case 
register as is the common practice, and the State 
system will be referred to as the State Central Case 
Record System. The major emphasis of the local 
register is case supervision; that of the State Central 
Record System is program management. 
Much serious thinking and study has been given to 
local tuberculosis registers during the last decade. 
One of the significant contributions in this field was 
made by E. X. Mikol in 1943 in his monograph, 
published by the National Tuberculosis Association.1 
Early in 1944 the U. S. Public Health Service initi- 
ated research projects to study various types of rec- 
INTRODUCTION 
1. Mikol, E. X., M. D., A Manual of Methods for Organizing 
and Maintaining a Central Tuberculosis Case Register, NT A, 
1943. 
1 ord systems for tuberculosis control activities. The 
study included case registers and central record sys- 
tems for health departments, as well as record systems 
for nursing and medical social services, clinics and 
sanatoria. The first phase of this research was the de- 
velopment of case record systems and registers for 
State and local health departments. The present man- 
ual, the first in a series, presents a detailed description 
of the State Central Record System and accompany- 
ing local registers, with special emphasis on installa- 
tion, operation and maintenance. 
A complete system of local case registers within a 
State would simplify the installation and maintenance 
of a State Central Case Record System. Therefore, in 
the opinion of many, the development of local case 
registers should precede the installation of State 
Central Record Systems. Accordingly, in its early 
phases the Public Health Service study was conducted 
in local health departments. Extensive preliminary 
planning consisted of a review of the potential func- 
tions of the case register, the determination of the 
relation between the agencies participating in tuber- 
culosis control, a study of various types of equipment, 
the designing of forms and the development of re- 
porting methods. Following this, several experi- 
mental local case registers were installed. 
As the study progressed, however, it appeared that 
the same mechanics were required to set up each local 
system and that much work was being duplicated. 
The same problems of determining sources of infor- 
mation, securing complete exchange of information 
and formulating plans for installation and mainte- 
nance had to be met for each local project. It was 
found also that local communities could neither sup- 
ply nor support trained personnel. Moreover, when- 
ever registers had been established independently by 
local health departments, there were variations among 
them, and the development of a State Central Record 
System from these different local registers presented 
additional complications. 
These and other difficulties led to the view that 
the establishment of a State Central Case Record 
System might be a better initial step in the develop- 
ment of tuberculosis case record systems. There are 
many thousand counties and independent cities in 
the United States, but only 48 States. Would not the 
prior installation of a State Central Case Record Sys- 
tem for tuberculosis and the existence of a trained 
statistician and supervisory field workers be a more 
effective method of developing local registers? Would 
not the total task, that of establishing both local and 
State systems, be simplified if the mechanics were 
applied first to the State as a whole and then extended 
to the local units? Once the State Central Record 
System is established, trained personnel, uniform 
methods and standard forms and equipment would 
be made available to local units. Would not the broad 
objectives of State and local systems be more easily 
realized by building a State Central Record System 
first? 
These questions were explored during field study 
projects in two States, Kansas and Oregon, where 
State Central Record Systems for Tuberculosis were 
planned and installed. Methods of approach were 
essentially those of installing local tuberculosis case- 
registers except for the larger scale of operations. Key 
officials and agencies were consulted, channels of 
reporting opened, forms devised and personnel re- 
cruited and trained. 
Although neither of the two projects has been in 
operation long, it has been amply demonstrated that 
a State Central Case Record System is workable and 
2 practicable. By field experience it has been shown 
that sources of information and reporting can be 
routed through a State Central Record System and 
that the Central Record System can be installed and 
maintained much the same as a local tuberculosis case 
register. Comparison between existing local registers 
and the proposed State Central Record System shows 
only one important difference, which is one of use. 
The local register is primarily a tool for individual 
case management, while the State Central Record 
System is essentially an administrative tool for pro- 
gram planning, supervision and evaluation. Since the 
State system does not require the detailed information 
necessary for case management, it may abbreviate, 
summarize or eliminate many of the f&cts necessary 
for a local health department register. 
The simple transcription and transfer to a local 
health department of its particular section of the 
State Central Record System becomes the first step 
in the installation of each local register. The State 
Central Record System in no way replaces the local 
register. In fact, one of the main justifications for 
a State Central Record System is the value of such 
a system in the establishment of local case registers. 
Instead of discouraging the development of registers, 
the existence of a State Central Record System stimu- 
lates their installation. Both are necessary because of 
differences in function; one actually complements 
the other. 
It is hoped that this manual will be useful to pub- 
lic health workers in the planning, establishment and 
operation of case record systems for tuberculosis. 
It outlines for the staff members of the tuberculosis 
control office their related responsibilities in estab- 
lishing and using the record systems. It will attempt 
to answer these questions: 
] What is a State Central Record System for Tuberculosis? 
2 Why is a State Central Record System needed? 
3, How large a task is the installation of a State Central Record System? 
4 What equipment is needed? 
5 How can information be interchanged? 
6. How are initial cases selected? 
1 How is a State Central Record System installed and maintained? 
8. How is a Local Register installed? 
How is a Local Register maintained? 
’ll What statistical data will the State Central Record System provide? 
3 WHAT IS A STATE CENTRAL RECORD SYSTEM FOR TKKUSBT 
The local case record system (the register) and 
the State system (The Central Record System) are 
both schemes for recording and organizing current 
medical and public health information about tuber- 
culosis. Early in the manual, therefore, it appears 
desirable to indicate how each system fits in the 
broad field of medical record keeping. 
Probably the most common medical case record 
system is that kept by the practicing physician for 
his own reference. Each case record is a series of nar- 
rative entries in chronological sequence containing 
whatever identifying data, diagnoses, treatment and 
progress notes the physician thinks will be useful in 
the management of his case. The record is intended 
for the private physician’s use alone, usually has little 
formal arrangement and has value only if the patient 
returns for treatment. It reflects the individualized 
interdependence between doctor and patient. One 
characteristic of that relation is that the patient de- 
cides whether he will return to the same physician, 
go to another physician or go to none at all. 
Hospital record systems represent a somewhat more 
complex scheme of case record keeping since they 
are essentially an aggregate of many physicians’ re- 
ports. Information entered on the hospital case rec- 
ord is contributed and used by many persons, and a 
greater degree of uniformity in the arrangement and 
content of the record is required. In the main, the 
source of information on each patient is the hospital 
staff, and the record is used only by the staff for 
direct management of the patient while he is hos- 
pitalized. Once the patient has left, the hospital 
usually can take no responsibility for the continua- 
tion of medical care. Again it is the patient who 
decides whether he will get further services, this time 
from the hospital; his decision determines the com- 
pleteness or currency of the hospital record. 
Clinic records are a further development in case 
record systems. They too are collections of individual 
case histories, uniformly arranged, drawn from the 
one source—the clinic—to be used by the clinic staff 
for individual case management. Because a clinic 
usually offers specialized services to a large number 
of persons, certain details of identifying data, 
4 examinations, diagnoses and treatment are always 
wanted, and the record forms are designed with 
definite positions for such details. A tuberculosis 
clinic record form, for example, may contain boxes 
for date and result of sputum examinations, date and 
impression of X-ray examinations, data on surgical 
treatment, laboratory findings, nursing and medical 
social service—all of which may be important in the 
treatment and management of the case. The clinic 
record system will ordinarily include records only for 
patients under treatment or those scheduled to return 
to the clinic, but the patient’s return is still his own 
responsibility. 
The services of all three groups, the private physi- 
cian, hospital and clinic are a response to the indi- 
vidual’s request for medical care. Although consid- 
erable information may be found in their case rec- 
ords, these records do not always contain the current 
status of the patient, since the volition for continued 
or current supervision is the patient’s. 
The local health department case records for a 
specific service embody a new point of view in med- 
ical record keeping. Because the health department 
has a responsibility broader than that of the private 
physician, hospital or clinic, its records reflect this 
social obligation. No longer is the health of the indi- 
vidual patient the focal point; it is the health of the 
community which concerns the health department. 
To meet its obligation to the public, a record is kept 
for each case of disease which threatens the com- 
munity’s health; and to be valuable this record must 
be accurate, complete and current. The health de- 
partment record system which supplies this current 
information is called a register; its currency dis- 
tinguishes a register from the previously described 
record systems. 
The health department uses its register in an at- 
tempt to make sure that each case has adequate med- 
ical supervision. The health department actively 
seeks out information from many sources, including 
clinics, public health nurses, hospitals, private physi- 
cians and laboratories; and the register becomes a 
summary of these reports. A local health department 
register includes not only data about those patients 
under a given supervision, but data on all patients in 
need of medical or nursing care. 
A local register needs fewer details of personal and 
medical history than a clinic or hospital record sys- 
tem. The register does not replace any of the clinic, 
nursing or hospital records but is rather an abstract 
of these records. Uniformity in arrangement and 
content of data becomes essential. The health depart- 
ment register places emphasis on the public health 
rather than on the clinical aspects of disease. For 
example, data on sputum is of importance not only 
to the clinic and the patient but also to the health 
department. However, while this information is used 
by the clinic primarily to furnish medical service to 
the patient, it is used by the local health department 
to prevent the spread of tuberculosis. 
The group that uses this summary record—the 
register—is no longer limited to those who furnish 
direct services to the patient, but includes the health 
officer, division director, public health nurse and med- 
ical social worker. The register is available to this 
group for individual case management, distribution 
of case-load and definition of local problems. 
The State Central Case Record System for a par- 
ticular service, such as tuberculosis, can be considered 
an extension of the local register plan. A State health 
department is charged with the protection of the 
health of the people of the State. Its function is to 
5 that proper isolation and care are given to the indi- 
vidual patient awaiting admission. This is the func- 
tion of the local health department in preventing the 
spread of infection to the household and community. 
On the other hand, when the State health depart- 
ment learns how many patients must wait long pe- 
riods for admission to a sanatorium, it can accurately 
appraise the need for hospital beds. 
The State tuberculosis division can develop sound 
programs only when it has authentic and current in- 
formation. A full knowledge of the tuberculosis 
problems of the State enables the State tuberculosis 
division to plan and operate a practical and effective 
program. The State Central Record System, because 
of current case histories, offers a quantitative meas- 
ure for such planning and administration. 
administer, plan, supervise and evaluate the public 
health program. The sources of information become 
more numerous and farther removed from the Cen- 
tral Record System. Current reports come in from 
local health departments, clinics, sanatoria, labora- 
tories and private physicians throughout the State. 
This material is abbreviated and succinctly summa- 
rized on standard cards for administrative use. 
Management of the case may not, in all instances, 
be affected directly by the persons who use the Cen- 
tral Record System, but it aids the division director 
and his staff in administering the State tuberculosis 
program. For example, when the local health de- 
partment knows that a patient must wait several 
months before admission to a sanatorium, it can prof- 
itably devote its efforts during this period to insure 
A State Central Record System for tuberculosis and the local tuberculosis case register may each be defined as a 
system of records for maintaining a current summary of pertinent medical and public health data on those proven 
and suspected cases of tuberculosis which, according to health department policy, require some type of supervision. 
6 WHY IS A STATE CEHTRUlRICOW SYSmi HEEDED ? 
tuberculosis control activities in State and local 
health departments throughout the nation have been 
accelerated during recent years. This development is 
due largely to the use of new methods of case finding 
which economically screen large groups of people. 
Widespread use of small film techniques has discov- 
ered more active, subclinical and suspected pulmonary 
tuberculosis than has ever been detected in the his- 
tory of public health. Such case-finding programs 
are now in operation on a large scale. 
Even a casual survey of local programs in tubercu- 
losis control reveals that quality and quantity of case 
finding has far surpassed performance in follow-up 
and case management. Although services of clinics, 
sanatoria and public health nursing have not devel- 
oped as rapidly as the techniques of case finding, plans 
are being made for great increase in follow-up and 
medical supervision. Increased assistance to local 
programs has become available through additional 
appropriations of Federal and State funds. The in- 
stallation of coordinated central record systems, State 
and local, is a problem of immediate significance if 
the full benefits of the new programs are to be real- 
ized. In too many instances not only have newly dis- 
covered suspects been inadequately followed, but also 
known active cases have remained unsupervised be- 
cause of the lack of administrative control which 
could have been provided by a Central Record Sys- 
tem. For this reason the installation of central case 
record systems, state and local, should become one 
of the first activities of a tuberculosis control pro- 
gram. In practice, tuberculosis record systems may 
be the essential administrative and statistical tool 
needed for development of adequate services. 
The usefulness of case registers for local health 
departments serving districts, cities or counties has 
been amply demonstrated. Their installation and use, 
nevertheless, has been limited to health departments 
with full-time health officers, clinic facilities and 
reasonably adequate public health nursing staffs. A 
local tuberculosis register serves to facilitate case 
management and helps direct an equitable distribu- 
tion of services for determining tuberculosis. A State 
Central Case Record System for tuberculosis offers a 
7 practical plan for accomplishing these purposes so 
vital to the Statewide tuberculosis program. 
It is possible that in some States the physical task 
of maintaining a large State Central Record System 
for tuberculosis would be extremely difficult because 
the system would be too cumbersome for practical 
use. Factors that influence the size of the task and 
volume of work are: 
1. Prevalence of tuberculosis 
2. Extent of case finding (mass X-ray service) 
3. Quality of reporting 
4. Amount of service for tuberculosis 
a. sanatoria 
b. clinics 
c. nursing and other field services 
d. laboratories 
e. rehabilitation 
5. Size and type of population 
Since it is impossible to judge the first four factors 
without field experience in the States, the factor of 
population, with full realization that it alone is inade- 
quate, can be taken as the best available criterion for 
defining which States should use State Central Record 
Systems. 
State Central Record Systems will not be recom- 
mended for the larger States in the United States 
(those with over four million population) because 
their operation in these States might be unwieldy. It 
cannot be definitely stated that Central Record Sys- 
tems are unworkable or impractical in these States, 
since further study is necessary before final decision 
can be made. However, this tentative population 
standard would exclude nine States. It is possible that 
more States would be eliminated after a study of other 
factors which might influence the size of the system. 
Such an appraisal should be made by each State de- 
partment of health that contemplates the installation 
of a Central Record System for tuberculosis. 
The States chosen for discussion may be divided 
into several categories according to the degree of 
development of public health services and the need 
for State Central Record Systems. (See Figure 1) 
In 1942, 10 States showed less than 25 percent of 
their population served by local full-time health 
officers. In 7 additional States, 25 to 49 percent of 
the population had such coverage; in 13 States, 50 to 
74 percent; in 14 States, 75 to 99 percent and in 4 
States, 100 percent of the population was served by 
full-time health officers. If the States were divided 
according to the percent of local health jurisdiction 
areas (city or county) served by full-time health 
officers rather than the percent of total population 
served, the lack of health department services would 
become even more apparent. 
In a State where all or most of the local health 
departments have well-developed services for tuber- 
culosis and well-functioning local registers, the addi- 
tional task of maintaining a State Central Record 
System may not appear to be justified. But even with 
these well-organized local services, a State Central 
Record System would provide valuable summary data 
to the State tuberculosis office for planning, super- 
vision and evaluation, and for consultation service to 
local health departments. 
There are also those States that have complete local 
health organizations with established tuberculosis pro- 
grams but few or no tuberculosis record systems. 
Here State health departments could render valuable 
service by assisting in the establishment of a uniform 
8 V/AVAV/WWW/AVV^VAV/AVl-AV/AV/iVAV^^^ 
''■■ Percent of Population Served by Local Full Time Health Officers and Ratio || 
of Public Health Nurses to Population, All States 1942 
Strereei Eme«oat ItUx&k M. local Bcakh tfote far i3» Naas&i New York* 1945. 
Region and State 
Population in 
millions, 
1940 
Percent of 
population 
served by 
local full 
time health 
officers 
Public healtli 
nurses per 
5,000 
population 
■ United States 
131.7 
66 
0.6 
'Jew England 
Connecticut 
1.7 
77 
0.9 
1 Maine 
0.8 
24 
0.4 
1 Massachusetts 
4.3 
67 
n.r. 
New Hampshire 
0.5 
43 
1.1 
- Rhode Island 
0.7 
40 
0.6 
1 Vermont 
0.3 
none 
0.7 
■iddle Atlantic 
| New Jersey 
4.2 
53 
1.1 
New York 
13.5 
77 
0.8 
m Pennsylvania 
9.9 
70 
0.5 
South Atlantic 
1 Delaware 
0.3 
58 
0.8 
j District of Columbia 
1.2 
100 
1.2 
Florida 
1.9 
70 
0.5 
•I Georgia 
3.1 
82 
0.6 
] | Maryland 
1.8 
100 
0.6 
North Carolina 
3.6 
92 
0.5 
South Carolina 
1.9 
100 
0.5 
)l Virginia 
2.7 
72 
0.4 
1 West Virginia 
1.9 
77 
0.3 
Iast North Central 
if Illinois 
7.9 
65 
0.5 
Indiana 
3.4 
12 
0.4 
■ Michigan 
5.3 
87 
0.7 
I Ohio 
6.9 
68 
0.5 
’Wisconsin 
3.1 
38 
0.6 
Region and State 
Population in 
millions, 
1940 
Percent of 
population 
served by 
local full 
time health 
officers 
Public health 
nurses per 
5,000 
population 
East South Central 
Alabama 
2.8 
100 
0.4 
Kentucky 
2.8 
90 
0.6 
Mississippi 
2.1 
89 
0.4 
Tennessee 
2.9 
89 
0.6 
West North Central 
Iowa 
2.5 
6 
0.3 
Kansas 
1.8 
41 
0.3 
Minnesota 
2.8 
34 
0.5 
Missouri 
3.8 
54 
0.4 
Nebraska 
1.3 
25 
0.5 
North Dakota 
0.6 
10 
0.4 
South Dakota 
0.6 
11 
0.4 
West South Central 
Arkansas 
1.9 
87 
0.4 
Louisiana 
2.3 
93 
0.6 
Oklahoma 
2.3 
61 
0.3 
Texas 
6.4 
56 
0.3 
Mountain 
Arizona 
0.5 
68 
0.8 
Colorado 
1.1 
53 
0.7 
Idaho 
0.5 
21 
0.5 
Montana 
0.6 
32 
0.6 
Nevada 
0.1 
15 
1.1 
New Mexico 
0.5 
100 
0.7 
Utah 
0.6 
14 
0.8 
Wyoming 
0.2 
13 
0.6 
Pacific 
California 
6.9 
93 
0.6 
Oregon 
1.1 
87 
0.7 
Washington 
1.7 
76 
0.7 system of local tuberculosis registers. In these States, 
though, the prior establishment of a State system 
would simplify the task of developing local registers. 
A study of the remaining States will reveal varying 
degrees of development of public health services. 
Some will have a dearth of health departments, clinics 
and nursing services. Many will lack sanatorium 
facilities. Most States, however, are contemplating 
expansion of local and State tuberculosis services. It 
is in these States that it is particularly important to 
install Central Record Systems to assist in the de- 
velopment of new and expanding local tuberculosis 
programs. Many of the States in the nation and a 
large number of local health departments will fall 
into this group. 
Of course, the development of a State Central Rec- 
ord System before the existence of local registers 
leads to many difficulties, the foremost of which is 
that, in the beginning, the State system must contain 
more elaborate information than would be necessary 
if local registers were in operation. Once local regis- 
ters are developed, the State can make the transition 
from complexity to simplicity with little effort. 
The State Central Case Record System will be use- 
ful to the State health department in fulfilling its 
responsibilities to: 
1. Assist in establishing local case registers 
2. Follow up suspects discovered by mass X-ray 
3. Provide a State-wide clearing center of information 
4. Guide and consult with local health personnel 
5. Follow up and supervise cases in areas without local health 
departments 
6. Plan the State wide tuberculosis control program 
1. Assist in establishing local case registers: 
Registers are recommended only if the local health 
workers actively support their installation. If the 
local health departments independently establish reg- 
isters, the lack of uniformity in record forms and 
definitions makes their coordination for State plan- 
ning a difficult problem. In many instances a health 
department may favor the installation of a tubercu- 
losis register but may be unable to proceed with the 
task because of lack of personnel familiar with re- 
porting methods and record systems. Since the regis- 
ter installation presents rather difficult technical 
problems requiring trained personnel, professional 
assistance from an outside source is often needed. 
The existence of a State Central Record System 
and experienced State personnel will simplify the 
local installation. By working out details, plans and 
procedures for the State, the State tuberculosis ad- 
ministrator and the records supervisor gain experi- 
ence which will be valuable in the establishment of 
local registers. At the same time the essentials of the 
local register are set up in the State Central Record 
System and can simply be copied and transferred to 
the local health office. 
2. Follow up suspects discovered by mass X-ray; 
Mass radiography is frequently a major activity of a 
State tuberculosis control division. Inasmuch as mass 
surveys are often planned or directed by the State 
tuberculosis division, it is the responsibility of the 
director to refer newly discovered suspects to health 
departments, physicians and clinics in order to (a) 
complete diagnosis, (b) insure supervision of newly 
discovered cases and (c) measure the quality of 
follow-up work. 
10 To realize the full value from mass surveys, sus- 
pects must be followed until those in need of medical 
care are brought under supervision and reported as 
cases. In many States too little attention is paid to 
this, the most important consequence of mass radi- 
ography. For this reason, the records of suspects 
revealed through mass X-ray should be included in 
the State Central Record System. Although follow- 
up of suspects is primarily a local health department 
function, a central plan can be formulated by use 
of the State Central Record System. 
3. Provide a State-wide clearing center of information: 
A State Central Record System is valuable as a clear- 
ing center for current information on cases and sus- 
pects reported from the many sources within a State. 
An efficient central system for interchange of in- 
formation will currently inform local health depart- 
ments of movements of their cases and changes in 
the medical status or supervision of patients, even 
though the source of the report lies outside the local 
jurisdiction or outside the State. It is of course de- 
sirable that reports from local physicians, public 
health nurses and clinics be routed through the local 
health department before transmitttal to the State 
Record System. But there is information from other 
sources, such as State clinics, sanatoria, veterans’ hos- 
pitals and out-of-State agencies, which can be most 
effectively distributed to the proper local health de- 
partment through one clearing center. Although this 
service of the State tuberculosis office could proceed 
in the absence of a Central Record System, the Rec- 
ord System will insure the continuance of service and 
act as a control against interruption or inadequacy 
of reporting from any source. 
4. Guide and consult with local health personnel; 
The Central Record System will give the State tuber- 
culosis division a continuous summary of medical 
and supervisory status of cases in each subdivision 
of the State. The State director must have such a 
summary to offer intelligent advice when assistance 
is needed by the State Public Health Nursing Direc- 
tor, the State Tuberculosis Nursing Consultant or the 
local health department. Equipped with this informa- 
tion, he is better able to discuss local problems with 
health officers and public health nurses. The plan- 
ning of new local facilities, such as increased nurs- 
ing service, clinics and mass X-ray services, will be 
guided by local needs which can in large part be 
ascertained from the local section in the State Cen- 
tral Record System. Missing and negative informa- 
tion about medical status and supervision of cases 
will highlight deficiencies. The need for additional 
services, such as those provided by sanatoria, clinics 
and public health nurses, is most effectively demon- 
strated by existing inadequacies. The Central Record 
System will provide data describing the local situa- 
tion such as number of active cases in the home, cases 
not under public health nursing supervision, and cases 
receiving no medical or nursing care. 
5. Follow up and supervise cases in areas without local health 
departments; 
Many States have a large proportion of counties with- 
out full-time health departments, and there may be 
no public health nursing service in these areas. In ad- 
dition to the known cases reported from these places, 
there are cases and suspects currently revealed through 
mass surveys, selective service examinations and re- 
ports of discharges from Army, Navy and Veterans 
11 Administration hospitals. If any public health nurs- 
ing follow-up is to be attempted, the State nursing 
division is directly concerned. Public health nurses 
from the State office are frequently directed to make 
home visits to certain classes of cases in these areas, 
and here a State Central Record System becomes an 
extremely practical tool for direction of services. 
While the State Central Record System cannot 
achieve the completeness and detail of a local regis- 
ter functioning in a well-organized health depart- 
ment, it can provide the nurse with knowledge of 
movements of cases, recent sanatorium discharges and 
suspects not re-examined. 
6. Plan the State-wide tuberculosis control program; 
Any State tuberculosis control program should be 
based upon factual data which in large part can be 
obtained only through a central record system. The 
planning of mass surveys, State clinics, and new sana- 
toria must take into account such factors as (a) geo- 
graphical distribution of new cases reported, existing 
cases, and deaths; and (b) type and extent of medical 
care, supervision and health department service being 
given to known tuberculosis cases in each local area. 
The State tuberculosis director has the task of plan- 
ning a budget. The combination of a statistical sum- 
mary and qualitative description of tuberculosis con- 
trol activities provides valid support to the adminis- 
trator who must justify his health program in terms 
of extent of the problem, effectiveness of activities 
and protection of the community. 
12 HOW LARGE A TASK IS THE INSTALLATION OF A STATE 
sJlSf EinRAi ttewisOTii? Ililllll 
The process of installing and maintaining a State 
Central Record System for tuberculosis is a major 
administrative and clerical task. Its difficulty should 
therefore not be minimized. An honest appraisal 
should be made of budget, personnel, office space and 
other facilities of the State tuberculosis division 
which are vital to the successful operation of a State 
Central Case Record System. 
The question of whether to establish a State Cen- 
tral Record System can be answered only after a 
careful consideration of three chief determinants. 
These may seem obvious, but there is great danger 
that one or all may be under-emphasized. 
1. The Central Record System must be genuinely wanted. 
2. Funds and personnel must be available for installation and 
maintenance of the Central Record System. 
3. The plan for the Central Record System most have the active 
cooperation of all persons and organizations concerned with 
tuberculosis control. 
1. The Central Record System must be genuinely wanted: 
This implies that the director of the tuberculosis 
division and the State health officer must have a sin- 
cere interest in the purpose and uses of the Central 
Record System. The tuberculosis administrator par- 
ticularly must be prepared for active personal par- 
ticipation during the period of planning and in- 
stallation. 
During the initial phases of work the director of 
the tuberculosis division must study and familiarize 
himself with the whole plan and devote much of his 
time to guidance and supervision of operations. After 
justifying the project in the State health department 
and securing budgetary approval, the director must 
personally assist in the coordination of sources of in- 
formation so that all reports will flow to the Central 
13 Record System (see Chapter 5). This means that he 
will confer with directors of sanatoria, laboratories 
and chest clinics, State nursing personnel and all local 
health departments to explain the record system, its 
uses and plans for interchange of information. 
In some places plans may involve changes in ex- 
isting record forms. Personnel for the Central Rec- 
ord System must be recruited and trained. Of utmost 
importance is the selection of a competent person to 
supervise the maintenance and use of the Central 
Record System. Office procedures in the State division 
must be correlated with the plan for the Record Sys- 
tem. These problems are emphasized because they are 
primarily administrative, and their solution is de- 
pendent on personal guidance from the director of 
the tuberculosis division. 
The director must realize that it is a difficult and 
time-consuming clerical task to set up a Central 
Record System. Sources of information with history 
and current status of known cases must be investi- 
gated. From these sources, previously reported cases 
must be located and their need for public health 
supervision determined. The clerical staff of the State 
tuberculosis division will be obliged to visit sanatoria, 
local health departments, clinics and other agencies 
to clear reported cases with existing case files. Pres- 
ent or last-known medical and supervisory status, 
location of cases, as well as any significant interme- 
diate case history must be summarized. The services 
of two experienced clerks for several weeks may be 
needed to clear the records in a single county of 
100,000 population. It cannot be over-emphasized 
that sifting and evaluating material for a Central 
Record System is a difficult and tedious task—even 
for trained and experienced personnel. 
2. Funds and personnel must be available for installation and 
maintenance of the Central Record System; 
This means that funds must not only be budgeted 
but must be available for equipment and additional 
personnel for installing and maintaining the Central 
Record System. 
Cost will vary widely with population size, inci- 
dence of tuberculosis, extent of reporting and amount 
of service. A conservative estimate, however, for 
States of one to two million population is $5,000 for 
equipment and initial installation and $4,500 per 
year thereafter for maintenance. Further analysis of 
the cost follows: 
Installation (Period of six months) 
Salary of record analyst 
@ $2,400 per year $1,200 
Salary of three clerks 
@ $1,500 per year 2,250 
Equipment and supplies 750 
Field travel and subsistence 500 
Miscellaneous 300 
Total $5,000 
Maintenance (Period of one year) 
Salary of record analyst $2,400 
Salary of one clerk 1,800 
Field travel and subsistence 300 
Total $4,500 
Larger States will require additional expenditures 
for equipment and clerical assistance. 
14 3. The plan for the Central Record System must have the active 
cooperation of ail persons and organizations concerned with 
tuberculosis control: 
All persons and agencies engaged in tuberculosis con- 
trol should display a willingness to cooperate in the 
plan for a Central Record System. During the period 
of installation, these agencies must agree to open their 
files to the State personnel who are clearing records. 
Those most concerned will be sanatoria, local health 
departments, clinics and nursing organizations, as 
well as community chest associations. Further, since 
the private physician will be the only source of in- 
formation for a large number of tuberculosis cases, 
some plan must be formulated for securing informa- 
tion about patients last reported under their care. 
Cooperation from private physicians can usually be 
secured to permit periodic queries about cases under 
their supervision. Both plans for initial clearing and 
subsequent periodic querying of private physicians 
should be presented to State and local medical soci- 
eties. Without the continued and complete inter- 
change of information the Record System cannot be 
successfully maintained as a current system. 
If the tuberculosis administrator is aware of the 
problems that may arise during the installation and 
maintenance of a Central Record System, he will be 
better prepared to deal with them. The slow rate of 
progress will not discourage him. If the director is 
reasonably sure that the prerequisites outlined in the 
chapter are met, and if he has secured the under- 
standing and cooperation of all persons and agencies 
concerned, the operations of installing a State Central 
Record System will become a smooth process. 
15 «M|lttiHPIIEHT|S NEEDED ? 
Filing equipment: 
Of the different types of filing systems, the visible 
files have many advantages for a Central Record 
System or register. Record cards are so arranged that 
one or two margins of many cards are visible at the 
same time. The visibility factor is important be- 
cause it permits rapid selection of record cards by 
name for reference or posting, and the use of mar- 
ginal signals contributes to rapid summary of in- 
formation and to better mechanical operation of the 
Central Record System. Each case record is signaled 
for attention, and there is less likelihood that it will 
be neglected or overlooked. The two best known 
types of visible filing systems are: 
1. Pocket visible: A serial arrangement of cards 
placed horizontally in drawers, with the bottom 
margin of each card visible. 
2. Vertical visible or off-set visible: A series of 
overlapping, vertically supported cards allowing visi- 
bility of the right vertical margin. A top corner cut 
gives an added visible margin at a readable angle. A 
plastic divider is the back support for each row of 
cards and separates it from the next row. Many rows 
of cards can be accommodated in a single unit, such 
as a specially designed desk drawer, a tub or file 
drawer. 
Both types of visible filing equipment have been 
used for tuberculosis record installations, but experi- 
ence indicates that the vertical visible file (figures 
2, 3) is superior for the uses of a State Central Rec- 
ord System. Card size may vary. Increased marginal 
area for signaling and a potential capacity of several 
thousand cards per unit make for a greater overall 
visibility. The pocket visible equipment, on the other 
hand, allows but one visible margin and permits a 
view of only about 60 cards at a time. In addition, 
hand-sorting for statistical tabulations is facilitated 
because cards are more easily pulled and refiled in a 
vertical file. 
The cost of vertical visible equipment for a Cen- 
tral Record System will be about one-half that of 
the pocket visible for a comparable capacity. Total Figure 2 
Figure 3 
Fig. 2 A desk model for vertical visible files. Each drawer 
contains three portable trays of cards. 
Fig. 3 Two portable trays for vertical visible cards. This equipment would be 
suitable for smaller health departments. 
cost of vertical visible installations will vary because 
the capacity of a given unit will depend on width 
and thickness of the cards and the number of divid- 
ers, The cards may be purchased from the company 
supplying the equipment or from the State printing 
office. In either instance, weight and composition of 
the card should be adequate for long use, since it 
will be used from the time a tuberculosis case is first 
reported to the time the case record is discharged 
from the Central Record System. 
Some of the companies manufacturing the vertical 
visible type of equipment and their products are 
Remington Rand—Kard-Site; Diebold—Tradex; Vis- 
ible Index Corporation—VISI-Record; Acme—Veri- 
Visible; Visual Records Corporation—Vis-U-All; and 
Hadley—Visible Record Trays. Kansas installed the 
VISI-Record two-drawer desk model with a capacity 
of 7,000 cards, for a total cost of $500. The desk 
model is a convenient arrangement for the record 
clerk because it serves as both file and work desk. 
Oregon purchased an Acme installation of two tubs, 
each with a capacity of approximately 3,500 cards, 
for $600. 
CENTRAL RECORD SYSTEM CARD: 
The Central Record System Card provides space for 
all significant aspects of case history which may be 
used for program planning, supervision and evalua- 
tion. Although there is a large variety of items to 
be recorded, the card must be compactly designed to 
simplify maintenance and reference. This design 
should include space only for available and necessary 
data. It must be emphasized that the record card in 
a State Central Record System is not a substitute for 
clinic or nursing records which call for specialized 
details. These details may be summarized, abbrevi- 
17 ated or omitted entirely from the State Central Rec- 
ord System. Because it is hoped that State Central 
Record Systems will foster the installation of local 
registers, and because the Record System for a par- 
ticular county will become the nucleus of the county 
register itself, there are advantages in the use of 
identical or similar cards in both systems. 
DESCRIPTION OF STATE CENTRAL RECORD SYSTEM CARD: 
The recommended card (figure 4) to be used in 
vertical visible filing equipment was developed after 
experimentation with tuberculosis registers in two 
local areas—Montgomery County, Maryland and 
Washington, D. C.—and State record systems in- 
stalled in Kansas and Oregon. This card is suitable 
for a local register or a State Central Record System. 
The suggested Record System card is divided into 
three sections: 
1. The upper one-third, horizontally lined for 
identification data and initial information. 
2. The vertical columns on the lower two-thirds 
of the card for current entries of medical history 
and treatment. 
3. The numbered boxes at extreme right for vis- 
ible signaling. 
Section 1 is common to all types of record cards 
and needs no discussion. Section 2 represents a de- 
parture from commonly used tuberculosis register 
forms. The proposed arrangement provides one 
chronological sequence for all entries concerning 
the patient’s medical status and supervision. All 
signficant events in the case history from the time 
a first report is received to the time the patient’s 
record is removed from the Record System are listed 
in their time sequence. Items as widely divergent 
as original case report, sputum examinations, clinic 
visits, sanatorium admissions and discharges are re- 
corded as they occur (figure 4A). 
In contrast, the card form recommended in the 
National Tuberculosis Association manual for tuber- 
culosis registers provides separated chronological se- 
quences for specific categories of information. All 
sputum results with dates of examination are assem- 
bled in one box. Hospital admissions and discharges 
appear in another box. Dates and readings of X-ray 
are entered in a third. To get a complete picture of 
the patient’s status, one must select information from 
many parts of the card. 
Experience of Public Health Service personnel with 
various card designs in many State and local installa- 
tions has shown that the proposed single chronological 
sequence has many advantages over the separation of 
related information into specific boxes. This single 
sequence does not sacrifice detail. It simplifies post- 
ing and reference. Since the last entry is the current 
information, the patient’s disease status is quickly 
determined. Related information at any given time 
is found on a single horizontal line and can be cor- 
related with preceding events. By surveying all entries 
in a single column, any one aspect of the patient’s 
case history can be summarized. Whether the pa- 
tient ever had a positive sputum may be determined 
from the sputum column. A glance at the column 
for supervision will show how many times the patient 
has been hospitalized. Further, the time relationship 
between the positive sputum record and hospitaliza- 
tion is readily seen because of the chronological order. 
Section 3 is the visible margin, the space re- 
served for signaling. Here, in addition to the first 
letter of each month, numbers which can have any 
desired reference designate signaling positions which 
18 MONTH 
NEXT 
REPORT 
IS DUE 
DATE 
DIAGNOSIS: 
FORM, STAGE,ACTIVITY 
SPUTUM 
UNDER MEDICAL 
SUPERVISION OF 
REPORTED 
BY 
REMARKS: REASON NOT HOSPITAL- 1 
IZED. REASON DISCHARGED. ETC.I 
3 
Figure 4 DATE 
DIAGNOSIS: 
FORM. STAGE, 
ACTIVITY 
SPUTUM 
UNDER MEDICAL 
SUPERVISION OF 
REPORTED 
BY 
REMARKS; REASON NOT 
HOSPITALIZED, REASON 
DISCHARGED, ETC. 
MONTH 
NEXT 
REPORT 
IS DUE 
Figure 4A 
allows for changes in the signaling code. Colored 
signals may indicate a summary of the supervisory 
status of cases, such as those in sanatoria, positive 
sputum or other active cases not hospitalized, or cases 
under no medical supervision. Signals may indicate 
when additional information is due and when action 
should be taken by the health department. They 
may also designate a group for special study or atten- 
tion, such as mass X-ray suspects. Each health de- 
partment will use a signaling plan which best suits 
its needs; the real significance of the signal, how- 
ever, is that it indicates action. 
SPECIFIC INFORMATION: 
Although there are certain types of information 
which should be common to all Central Record Sys- 
tems, no one form can be universally suitable. A 
special problem in one State may suggest the inclu- 
sion on its Record Card of an item relatively unim- 
portant in another. For example, the Tuberculosis 
Control Division of Kansas was concerned with the 
problem of establishing pneumothorax stations, since 
there were many areas with no facilities for refills. 
Therefore, Kansas Record System cards are designed 
to indicate whether the patient is receiving pneumo- 
thorax. If local health departments plan to install 
registers based on the State Central Record System, 
it is advisable to use identical cards for both State 
and local systems. In that event the State card may 
be designed to include space for information not 
needed by the State health department but wanted 
by the local health departments for management and 
supervision of cases. The Kansas and Oregon Record 
System cards were designed for use both in State 
Central Record Systems and local registers. 
20 Classification of the items on the proposed 
FORM FOLLOWS: 
Identification and initial information 
Case identification 
County 
Case number 
Name 
Address 
Birthdate 
Age 
Sex 
Color 
Marital status 
Occupation 
Place employed 
Under PHN supervision 
Yes or no 
Agency supervising: (e.g., health department, 
school or name of private nursing agency) 
Reason not under PHN supervision 
Legal settlement or residence and veteran status 
Information to determine eligibility of patients for 
sanatorium care and to evaluate the scope of the 
veteran and non-resident problems 
Reason for referral 
What prompted first examination for tuberculosis, 
(e.g., symptoms, contact, mass X-ray suspect, 
Selective Service examination. Army or Navy dis- 
charge) ? 
Date 
Enter month and year of referral 
Official morbidity report 
Reported by: (e.g., name of physician, clinic, 
health department, sanatorium or other agency) 
Date of report 
Enter date of first official morbidity report 
Chronological history of medical supervisory status 
Date of report 
Diagnosis 
Sputum 
Medical supervision 
Reported by 
Remarks 
Month next report or examination due 
Optional information on reverse side of card 
Whether additional information is carried on the 
Record cards will depend on State policy regarding 
supervision of cases. If actual supervision is con- 
ducted from the State tuberculosis division and if a 
system of local registers is planned, additional in- 
formation may be desired on the State Record Cards. 
Other agencies 
Date each nursing visit was made 
For each contact: 
Name of contact 
Relationship to case 
Year of birth 
Sex 
Color 
Date examined 
Diagnosis 
Date due for re-examination 
21 NOW CNN INFORMATION BE INTERCHANGED?Ill 
TO maintain current information on cases is a 
fundamental function of the State Central Record 
System. Without this the System deteriorates into 
little more than an index of reported cases. All po- 
tential sources of information must be thoroughly 
investigated, and plans must be formulated and ap- 
proved for maintaining a flow of essential informa- 
tion through the Record System. Information must 
circulate to the State health department, local health 
departments and all other agencies or individuals who 
are concerned with examination, diagnosis, treatment 
or supervision of tuberculosis patients. Only the co- 
ordination of records and reporting methods from 
these agencies will insure continuous and complete 
interchange of information. A scheme must be put 
into operation which will tap all sources of informa- 
tion for the State Record System. Thus, private phy- 
sicians, sanatoria, tuberculosis associations, health de- 
partment clinics and nurses, and private nursing or- 
ganizations must be acquainted with full details of 
the Record System. Only if their continuous coop- 
eration in reporting is secured will it be a current live 
record system. 
In addition, the Record System becomes a central 
clearing house for information which is originally 
reported directly to the State tuberculosis division. 
This distributon of information is the service the 
State tuberculosis division renders to other agencies 
in return for their reports. 
22 GENERAL PLAN FOR INFORMATION INTERCHANGE: 
The procedure for interchange of information between the State Central Record System and other agencies will 
vary of course, and must be adapted to the facilities and policies of each State. In general, the interchange of 
information could follow this pattern: 
1. All information originating from private physi- 
cians, local health department clinics, city and county 
sanatoria, laboratories or other institutions in an 
area with a full-time health department will be sent 
first to the local health office. The information may 
be entered on the local register, then forwarded to 
the State Central Record System. 
2. All information starting from a State, Federal, 
or private institution will be sent directly to the 
State tuberculosis control office. After entry in the 
State Central Record System, the information will 
be forwarded to local health departments. In addi- 
tion, information about patients in counties without 
full-time health officers may reach the State tuber- 
culosis division first. This too will be routed to per- 
sons supervising public health work in local areas. 
23 A 
ISN information interchange form (figure 5) patterned after the Record System card is suggested for transmit- 
ting and requesting information from State and local health departments. This form may be originated by either 
health department. For example, the nurse reports that a patient has moved to another county. The form first 
reaches the local register and then the State Central Record System. On the other hand, the State Central Record 
System may use the same form to report to the nurse in the county to which the patient has moved. Sources of 
information and reports with suggested procedures for routing follow: 
TUBERCULOSIS INFORMATION INTERCHANGE 
(Among Central Record System, local register and Public Health Nurse) 
To Date 
From 
Complete all items 
Complete items checked and make necessary corrections 
For your information only 
Case No. 
Name 
Address 
New address? 
Birth date 
County of residence 
Marital status 
Occupation Where employed 
Under PHN ~ Supervising agency: 
supervision C]Yes DNo Reason not supervised: 
Legal settlement in State; [jYes DNo In county: □ Yes □ No Veteran: □ Yes □ No 
Hospitalization Y Reason not 
recommended 1 es i-iNo hospitalized 
Reason for referral; Specify what prompted the first examination 
Age Sex Color 
Symptoms 
Contact 
Mass x-ray 
Special occupation group 
(e.g., food handler, etc.) 
Selective Service Examination 
Army or Navy Discharge 
Veteran’s Hospital Report 
Interstate referral 
Other 
Date report Diagnosis „ Under medical 
or visit Form, stage, activity **u um supervision of Remarks 
Other services to family (Agencies, etc.?) 
Remarks: 
The Public Health Nurse will originate this form to report new information which will 
include; 
1. Change of name and address 
2. Change of marital status 
3. Change in occupation or place employed 
4. Admission to or discharge from 
PHN supervision 
5. Change of medical supervision 
6. Change in service rendered by 
other agencies 
7. Death from a cause other 
than tuberculosis 
Report by Date 
Figure 5 
24 REPORTS 
b MORBIDITY REPORTS 
In all States, either by law or health department 
regulation, tuberculosis is a reportable communicable 
disease. The attending physician in some States re- 
cords only the name and address of the patient and 
“tuberculosis” on a general epidemiological report. 
In others, a special tuberculosis report form such as 
figure 6 is used, which provides more specific in- 
formation concerning address, age, sex, color, marital 
status, occupation, legal residence, stage and activity 
of disease and sputum tests. Figure 6 is preferable 
because it gives public health workers information 
needed for identification of the patient and some 
basis for intelligent follow-up. 
reach the State Central Record System. The first 
case report may constitute the first entry in a State 
Central Record card. 
b CLINIC REPORTS 
Chest clinics are the best sources of information 
about the current medical status of patients under 
their supervision. Clinic records will supply data 
concerning last X-ray reading, sputum analysis, gen- 
eral recommendations and date due for re-examina- 
tion. It should be possible to obtain such information 
CLINIC 
TOWN 
COUNTY 
DATE 
TUBERCULOSIS CLINIC REPORT 
CLINICIAN 
CLINIC NURSES 
Volunteer* and Attendant* 
DIAGNOSIS AND REMARKS 
REPORT OF A TUBERCULOSIS CASE TO 
STATE HEALTH DEPARTMENT 
Name and Addreaa 
AGE 
SEX 
COLOR 
Referred 
by 
IF CONTACT. NAME 
OF SOURCE CASE 
To Clinic 
Ntwjpld 
BIRTH DATE 
OCCUPATION 
SEX COLOR 
RESIDENCE IN Q UNDER 1 YEAR 
STATE: □ I YEAR ON OVER 
MARITAL STATUS 
19 
NUMBER OF FAMILY CONTACTS: UNDER 15 YEARS 15 YEARS OR OVER 
FORM AND STAGE OF DISEASE IMPRESSION OF ACTIVITY SPUTUM 
MINIMAL 
MODERATELY ADVANCED 
FAR ADVANCED 
OTHER. SPECIFY: 
PROBABLY ACTIVE 
ACTIVITY UNDETERMINED 
PROBABLY INACTIVE 
POSITIVE 
NEGATIVE 
NO EXPECTORATION 
NOT EXAMINED 
Total 
FAT I ENT WILL BE SUPERVISED BY: □ MYSELF Cl OTHER. SPECIFY 
DIAGNOSIS CONFIRMED BY X-RAY: Q YES □ NO 
Figure 7 
Total Number at Clinic 
Figure 6 
from all public clinics. Private clinics should also 
be encouraged to submit similar reports. In some 
instances it may be feasible to obtain a duplicate of 
the whole clinic record. However, this is apt to be 
much more detailed than necessary for the Record 
System. The suggested clinic report (figure 7), de- 
signed particularly for Record System and register 
use, contains only the information needed for these 
systems. The report from the local health department 
Such reports are ordinarily routed through the local 
or county health department which forwards either 
the originals or duplicates to the State health office. 
In cities or counties without health departments, the 
physicians usually send the reports directly to the 
State office, and they are routed to field personnel in 
the area. In either situation, case reports ultimately 
25 clinic should be first abstracted on the nursing rec- 
ords and register and then sent on to the State Cen- 
tral Record System. Clinics operated by the State 
sanatorium or State tuberculosis division may report 
directly to the Central State Record System, After 
entry of pertinent data on the record card, the report 
will be forwarded to the local health department. 
• PUBLIC HEALTH NURSING REPORTS 
Public health nurses are the health department repre- 
sentatives who have, through home visits, the most 
frequent contacts with tuberculosis patients. They 
are indispensable sources of information for the Rec- 
ord System. They can report change in address, 
change in medical supervision or examination of 
contacts. To standardize the information originating 
from the many nurses throughout the State, the in- 
terchange form (figure 5) suggested earlier is help- 
ful. Pertinent material is transferred from the nurs- 
ing record to this interchange form and routed to 
the local register and the State Central Record Sys- 
tem. Nurses report whenever a visit reveals new 
information which supplements or changes that 
already recorded. 
• HOSPITAL ADMISSION AND DISCHARGE REPORTS 
The value to public health workers of hospital ad- 
mission and discharge reports which indicate a change 
in the patient’s medical supervision cannot be over- 
emphasized. The use of the State Central Record 
System as a clearing center insures that sanatorium 
reports will be available to all concerned in time for 
effective use. Many sanatoria voluntarily notify 
health departments and private physicians who are 
to supervise cases after discharge. This clerical task 
for the sanatorium is simplified if reports are sent 
to one clearing center which forwards them to local 
health departments. The local health department 
wants to know about admissions and discharges as 
they occur. Prompt reporting of discharges is par- 
ticularly important because it is immediately follow- 
ing discharge that the patient should be brought 
under public health supervision. At this time local 
DAILY HOSPITAL ADMISSION SUMMARY 
HOSPITAL 
ADMISSIONS DATE 
PATIENT S NAME I COUNTY Of| REFERRING AGENCY OR 
AND ADDRESS RESIDENCE PHYSICIAN’S NAME 
Figure 8 
DAILY HOSPITAL DISCHARGE SUMMARY 
HOSPITAL 
DATE 
PATIENT’S NAME COUNTY OF 
AND ADDRESS RESIDENCE 
DISCHARGED 
DIAGNOSIS ( including 
clinical status) 
SPUTUM 
RECOMMENDATIONS 
Figure 8A 
HOSPITAL DISCHARGE REPORT 
torn* of Institution) 
Date 
PATIENT’S 
PATIENT’S ADDRESS maiden) COUNTY OF 
ON DISCHARGE RESIDENCE 
dUcharge CD advice D advice O AWOL O plinary Q death D other 
Form and Stage 
□ PRIMARY 
□ MINIMAL 
□ MOD. ADVANCED 
□ FAR ADVANCED 
O OTHER (Specify) 
DIAGNOSIS ON DISCHARGE ~ 
Activity Sputum 
] ACTIVE 
1 QUESTIONABLY 
ACTIVE 
iINACTIVE 
] POSITIVE 
]NEGATIVE 
□ FURTHER EXAM. 
NOT INDICATED 
□ RE-EXAM. IN 
MONTHS 
RECOMMENDATIONS 
PER y118 WORK 
NO. WEEKS BEFORE 
RECOMMENDED 
□ AMBULANT 
TREATMENT 
□ PNEUMOTHORAX TO 
BE CONTINUED 
1. Type work recommended 
2. Recommended by — _ , 
. _ . . (physician or vocational rehab, director) 
I. Rehabilitation 
Service with which patient is registered' 1 ” 
Remarks: Other significant findings, surgery, complications; 
Figure 9 
26 health officers and nurses are interested in diagnosis, 
sputum and reason for discharge, as well as in recom- 
mendations for the patient’s care. 
Daily admission and discharge reports (figures 8 
and 8A) may be requested from State and large 
county sanatoria; weekly summaries from smaller 
sanatoria may be more practical. A detailed indi- 
vidual discharge report (figure 9) for each patient 
is preferable because after its entry in the State Cen- 
tral Record System it is easily forwarded to the 
proper local health department. Further, if a sana- 
torium uses a summary report containing information 
for a group of patients, it becomes necessary for the 
State office to copy for each local health department 
the information about its cases. 
• REPORTS FROM PRIVATE PHYSICIANS 
To learn the status of disease of all tuberculosis pa- 
tients in the community, the health department needs 
a periodic report on those patients under the super- 
vision of the private physician. 
Many patients do not remain under the care of one 
physician; many do not return to any physician for 
responsibility is to make sure that they are under 
some continued and current supervision. It is recom- 
mended that, if possible, current status on this group 
of patients be determined at 6-month intervals. The 
State tuberculosis division should initiate the queries 
which are directed to the local health departments. 
They in turn secure the information from the private 
physicians. The local health department may do this 
by means of a form such as figure 10, a telephone 
call or a nurse’s visit to the private physician. 
• LABORATORY REPORTS 
Sputum examinations may be done in State, local or 
private laboratories, and ordinarily it is possible to 
obtain a report of each examination. Both positive 
and negative sputum reports should be routed to the 
Central Record System. The positive sputum report 
is of special significance to the health department, 
as it indicates a possible danger to the community 
and an active case requiring medical care. The nega- 
tive report yields important information concerning 
the whereabouts of cases and their current medical 
supervision. Often, presumably lost cases are located 
through information contained on sputum reports. 
Reports originating in the laboratory of a city or 
county health department are routed to the local 
health department and then to the State Central Rec- 
ord System. However, reports originating in the 
State or sanatorium laboratory are routed through 
the State Central Record System first. 
• DEATH REPORTS 
In order that the Record System be maintained as a 
current file, deaths of all tuberculosis cases must be 
reported to it. The State vital statistics division can 
supply much of the necessary information. Copies or 
PHYSICIAN S PERIODIC REPORT OF A TUBERCULOSIS 
CASE TO STATE HEALTH DEPARTMENT 
19 
NAME OF PATIENT REPORTED AS UNDER YOUR CARE 
ADDRESS 
IS ADDRESS CORRECT? YES 
PRESENT STAGE OF DISEASE 
□ MINIMAL C 
□ MODERATELY ADVANCED [ 
□ FAR ADVANCED Q 
□ OTHER. SPECIFY: 
DIAGNOSIS 
IMPRESSION OF ACTIVITY 
PROBABLY ACTIVE 
ACTIVITY UNDETERMINED 
PROBABLY INACTIVE 
□ POSITIVE 
□ NEGATIVE 
J NO EXPECTORATION 
□ NOT EXAMINED 
Figure 10 
PATIENT IS UNDER MY SUPERVISION YES □ NOQ DATE OP LAST X-RAV_ 
APPROXIMATE DATE PATIENT TO RETURN 
care. Although the health department does not give 
direct medical care to all tuberculosis patients, its 
27 transcriptions of the original death certificates are 
sent to the Record System. For future reference and 
study they should be kept in a permanent file in the 
State tuberculosis control division. Not only death 
certificates on which tuberculosis is assigned as the 
primary cause, but all certificates mentioning tuber- 
culosis should be included. Search for death certifi- 
cates mentioning tuberculosis should be conducted 
routinely each month by personnel of the vital sta- 
tistics division. These certificates must be selected 
by reading or scanning all causes of death on all cer- 
tificates. Death certificates for residents who have 
died in other States are also available in the vital sta- 
tistics division and special request should be made to 
the State registrar to secure them. In addition, there 
will be instances when tuberculosis is not mentioned 
as a cause of death on the certificate of a patient 
previously reported as a tuberculosis case. When local 
health departments obtain knowledge of such a death 
they should forward the information to the State 
Central Record System. The State tuberculosis di- 
vision will, for its part, inform local health depart- 
ments of all tuberculosis deaths among the local 
residents, particularly those occurring outside the 
local area. 
• OTHER REPORTS 
Any additional case information received in the State 
tuberculosis division should be cleared with the Rec- 
ord System. Interstate reciprocal reports, Selective 
Service referrals, reports on mass survey suspects and 
general correspondence contain current data on loca- 
tion of patients and their medical and supervisory 
status. These reports are usually directed from the 
primary source to the State tuberculosis division, 
and according to the general plan for routing, they 
are then forwarded to local health departments for 
action. As a general procedure all correspondence, 
reports and records in the State tuberculosis office are 
directed to the Record System clerk who abstracts 
pertinent information and routes the report. 
28 how tKE luifttt 
GENERAL CONSIDERATIONS 
The planning of a State Central Record System 
raises two questions: Which cases shall be included 
in the Record System? To what extent will they be 
investigated? A State Central Record System could 
be started with only newly reported cases if no file 
of previously reported cases can be obtained at the 
start. 
Previously reported cases under the direct super- 
vision of health departments could be added as nurs- 
ing or clinic reports are received. Actually, it seems 
desirable to start with all cases reported in recent 
years, in order to profit from past case reporting. 
The extent of investigation of previously reported 
cases will be determined by number and quality of 
personnel for clearing activities, as well as by the 
availability and kind of information which may be 
found in sanatoria, clinics and health departments. 
The official case reports for the years selected will 
include not only all known living cases but cases 
dead, lost, moved out of the State, healed, or in no 
need of supervision. To eliminate those cases no 
longer in need of medical supervision is one purpose 
of initial clearing operations. By the same operations 
it is also possible to obtain a certain amount of inter- 
mediate and current case history on those cases which 
will constitute the State Central Record System. 
A well-staffed State office with an adequate budget 
could arbitrarily elect to investigate all cases re- 
ported during the last ten years. This group would 
include almost all known cases in the State. But 
much of the work would be unprofitable because a 
high percentage of cases will be found to be dead, 
lost, moved out of the State or not in need of super- 
vision. On the other hand, if only new cases or those 
reported within one year are included, considerable 
time must elapse before the Record System gives a 
complete picture of the known case load. Many States 
will be able to investigate morbidity reports received 
during the past several years. Few will be able to go 
back as far as ten years, and few will wish to start 
with new cases alone. 
A conservative yet practical procedure is the in- 
vestigation of cases reported in the last five years. 
Investigation should cover all cases for whom some 
29 report has been received in the stated period, even 
though they may have been originally reported many 
years before. It will be found that a five-year group 
will include most of the known active cases in any 
area. Missed cases will be added to the Record Sys- 
tem as additional reports are received through any 
of the channels set up for reporting. 
In Kansas and Oregon, after perfunctory investi- 
gation through readily available sources, cases were 
classified into three categories: 
1. Cases eliminated as lost, moved out of State, dead, 
non-tubcrculous or not significant for follow-up 
according to State policy. 
2. Cases known to be under some medical super- 
vision or in need of medical care. These cases 
will constitute a large part of the final Record 
System. 
3. Cases whose supervisory and medical status is 
unknown. This group may be held in a separate 
file pending a gradual yet more intensive in- 
vestigation by local health departments. 
At the close of initial clearing operations for 
Kansas in November 1945, there was the following 
disposition of cases originally reported during the 
years 1940 to 1944: 
November 1945—Disposition of Cases Originally Reported in Kansas from 1940-1944. 
Year of 
first case 
report 
Total 
reports 
Cases remaining in Record System , 
Cases excluded from 
Record System 
Last report received within 
past 12 months 
Last report received over 
1 year previously 
Dead, arrested, moved out of 
State, lost, or not significant 
for follow-up 
Number 
Percent 
Number 
Percent 
Number 
Percent 
Total 
3,688 
733 
19.9 
602 
16.3 
2,353 
63.8 
1940 
757 
86 
/ 11.4 
125 
16.5 
546 
72.1 
1941 
829 
98 
11.8 
145 
17.5 
586 
70.7 
1942 
698 
129 
18.5 
131 
18.7 
438 
62.8 
1943 
697 
157 
22.5 
109 
15.6 
431 
61.9 
1944 
707 
263 
37.2 
92 
13.0 
352 
49.8 
Investigation showed that 72 per cent of the initial 1940 cases were closed as compared with 50 per cent of the 
1944 cases. Furthermore, there had been a report within the last 12 months for only 11 per cent of the cases 
first reported in 1940, compared with reports for 37 per cent of the cases originally reported in 1944. 
30 PRELIMINARY STEPS IN CLEARING 
Because it is difficult to transfer information in its 
proper chronological sequence from the many sources 
directly to the final Record System card, the mechan- 
ics of clearing are simplified by the use of an inter- 
mediate record or worksheet patterned after the Rec- 
ord System card. The worksheet can be multilithed 
or mimeographed as soon as the final draft of the 
Record System card is approved. A worksheet is 
started for each case reported by official morbidity 
report in the selected time period. In the process of 
clearing with different sources, supplementary in- 
formation will be added to each worksheet. Finally, 
after duplicate reports are combined and entries are 
arranged in chronological sequence, the Record Sys- 
tem card is prepared by editing the contents of the 
worksheet and transcribing them to the card. 
SEARCHING RECORDS 
1. DEATH REPORTS 
Elimination of worksheets for deceased cases should 
be the first operation in clearing. Much fruitless 
searching will thus be avoided. The size of this op- 
eration will vary among States, since some State tu- 
berculosis divisions may have already indicated the 
fact of death on the case reports. 
One way to clear for deaths is to match the work- 
sheets against the index of deaths in the State vital 
statistics division. This index will normally include 
not only deaths occurring in the State but deaths of 
residents occurring anywhere in the United States. 
2. SANATORIUM RECORDS 
As sanatorium and out-patient clinic records contain 
significant material for many cases covered by the 
Record System, it is advisable to transport all the 
worksheets to each sanatorium in turn, in order to 
check against sanatorium records. State or county 
sanatoria will usually grant permission for clearance 
activities. Privately owned or Federal sanatoria may 
allow inspection of their records; if not, information 
may be obtained through written query. 
The worksheets should first be compared with a 
master index of the sanatorium and records pulled 
for Record System cases which have been hospitalized. 
A list of all patients in the sanatorium and under 
sanatorium clinic care should be checked to ascer- 
tain whether there are any patients under treatment 
for whom there are no worksheets. For these, work- 
sheets will be added. In some States all sanatoria may 
be under one governing body, such as a State Board 
of Health or Department of Public Welfare, which 
may have one central file of case abstracts. Under 
such a system the task of clearing cases with sana- 
torium histories will be greatly simplified. 
3. LOCAL HEALTH DEPARTMENT RECORDS 
Public health nursing records 
Public health nursing records will be the main source 
of information for clearing. The worksheets, sorted 
according to the city or county of residence of pa- 
tient at the time of last report, can be taken to the 
local health department. There they can be checked 
with family folders or other nursing records. Three 
purposes will be served in this clearing operation. 
First, a certain percentage of the cases may be 
eliminated because of death, change of residence to 
another State or because the patient no longer needs 
supervision. Second, current medical status, super- 
vision and other information may be added to the 
worksheets. Third, additional active cases under 
31 public health supervision will turn up. Cases in this 
third group may not have been previously reported 
or may have been reported before the time interval 
selected. A Record System worksheet will be pre- 
pared for each of these patients. 
The amount of information to be gained from the 
nursing records of course will vary with the extent 
of development of local tuberculosis control activi- 
ties and particularly with the amount of nursing 
service for tuberculosis. Full-time city and county 
health departments will have records with detailed 
histories of medical and supervisory status and in- 
formation on examination of contacts. On the other 
hand, in counties and cities with inadequate nursing 
staffs, data in the nurses’ records may be scanty. In 
fact, little more may be ascertained than the patient’s 
place of residence. 
The family folder or case record for tuberculosis 
may not be the only source of information. Inquiry 
should be made concerning all tuberculosis records 
in the local health department. Other possible sources 
may be individual tickler files, correspondence and 
unfiled reports. The review of nursing records should 
be carried out with as much personal assistance as 
possible from the nursing staff. Due to current short- 
age of nursing and clerical personnel, many health 
department nursing records may be incomplete, and 
much pertinent material needed for clearing will be 
secured through discussion with the public health 
nurses. 
Care must be exercised to abstract from nursing 
records only that information which defines current 
supervisory and medical status of the patient and 
those details of the case history which are important 
for future supervision and follow-up. 
Clinic records 
Several types of chest clinics may be in operation in 
a State, and they will generally allow inspection of 
their records. The entire health department clinic 
file should be checked against the worksheets. The 
same procedure should be followed for private clinics, 
but if this is impossible, information can be obtained 
through correspondence with the clinic director. 
4. REPORTS FROM PRIVATE PHYSICIANS 
Determination of current status of patients last re- 
ported under the care of private physicians should be 
the last step in clearance to avoid querying physicians 
about cases whose status could have been learned 
from other sources. The proportion of cases for 
whom the private phyisician is the only source of 
current information varies widely from one com- 
munity to another. 
To learn whether a patient is still under the super- 
vision of the physician who last reported the case is 
a difficult but necessary task. Investigation will show 
that a high percentage of the old reported cases are 
under no known supervision. This indicates the need 
for more careful and current follow-up. Some of 
these cases should be reopened for health department 
service, some should be under sanatorium or clinic 
care and others may not be in need of public health 
supervision. 
A personal visit by the health officer or nurse to 
the private physician, a telephone call or a mailed 
query are the principal methods of obtaining infor- 
mation promptly. The first two may be possible in 
some city or county health departments and will be 
effective. Mailed queries may be the only means of 
reaching some physicians. Whenever the mailed query 
32 is selected as the method, it should be signed and 
sent by the local health officer. 
The content of the query form (figure 11) will 
greatly influence its usefulness; if too much is asked, 
the returns are liable to be poor. The present location 
of the patient and the type of his medical supervision 
is the information most wanted. Additional questions 
can be added if full reporting is anticipated. It will 
often be found that a number of cases for which 
there are no previous morbidity reports will be 
reported at this time. In counties with full-time 
health departments and established tuberculosis con- 
trol programs, where the medical societies are in full 
accord with the program, a rather detailed question- 
naire may be used. In addition to information on 
supervision, diagnosis on last X-ray and results of 
sputum examination may be requested. In a county 
with neither a health department nor a nursing serv- 
ice, it is doubtful whether the query should request 
anything more than type of current medical super- 
vision. 
accompanied by a query form listing cases last known 
to be under his supervision. The 64 percent of the 
physicians who answered the queries returned in- 
formation on 316 cases, or 61 percent of the original 
515 cases. Of the 316 cases, 21 percent were reported 
to be still under the supervision of the physician to 
whom the query was sent, 14 percent were reported 
to be under the supervision of another physician or 
hospital, totaling 3 5 percent under known super- 
vision. In addition, 19 percent were known to be 
either arrested or dead. The remaining 46 percent 
were not known to be under medical supervision. 
RESULTS OF CLEARING 
After worksheets have been cleared with all sources 
of information and those for cases needing no public 
health supervision are eliminated, those remaining 
will represent cases under medical care or in need 
of public health supervision according to local pol- 
icies of case management. Analysis of the latter 
group will indicate that the current status of many 
cases is not known. If "current” means that any 
report on a case has been received within one year, 
information in the Kansas inventory was 68 percent 
current after perfunctory clearing; in 32 percent of 
the cases, there had been no report for over a year. 
On the same basis, 72 percent of the inventory in- 
formation in Oregon was current. It is recommended 
that the section in any State Central Record System 
corresponding to the 32 percent in Kansas and the 
28 percent in Oregon be included in the Record Sys- 
tem but segregated or signaled for later gradual 
investigation by local or State field personnel. 
After all clearing operations are completed, in- 
formation will be transcribed to the permanent Rec- 
ord System cards. 
Figure 11* 
To show the results of querying physicians in 
counties without full-time health departments, the 
following experience in Kansas is cited. Letters were 
mailed to 239 physicians requesting information 
about 515 cases. Each physician received a letter 
33 SPECIFIC PROCEDURES FOR INITIAL CLEARANCE OF CASE RECORDS 
A. PRELIMINARY 
1. Prepare a work sheet from the case report file in 
the tuberculosis division for each case reported 
within the selected time interval. 
Copy all pertinent information: 
a. identifying data 
b. diagnosis 
2. Arrange work sheets in alphabetical sequence by 
case name. 
3. When other cases are found in the process of 
searching, prepare a worksheet for each additional 
case. In clearing these worksheets with various 
sources such as sanatoria and health departments, 
search for tuberculosis cases in such files for which 
there are no worksheets. There will ordinarily be 
many of these. 
B. SEARCHING RECORDS 
1. Deaths 
a. check all work sheets against State death 
index, 
b. on work sheet enter date and fact of death. 
2. Sanatorium records 
a. Hospital case histories 
(1) Check case histories against work 
sheets 
(2) Enter on work sheets 
dates of each admission 
diagnosis on admission 
diagnosis for patients in sanatorium 
at present 
date of each discharge 
reason for each discharge 
diagnosis on discharge 
sputum on discharge 
present medical supervision of dis- 
charged patient 
b. Sanatorium clinics 
(Out-patient records may be found with 
sanatorium case histories) 
Enter on work sheets 
date of most recent clinic visit 
diagnosis at last visit 
last recommendations (treatment, 
supervision) 
date, results of most recent sputum 
examination 
Rearrange worksheets alphabetically by local health 
department jurisdiction 
3. Local Health Department records 
a. Public Health Nursing records 
(1) Check worksheets with public health 
nursing records, family folders, corre- 
spondence, tickler files 
(2) Enter on worksheet 
present address of patient 
present medical supervision (name 
of private physician, clinic or 
sanatorium) 
date of last medical supervision 
dates of each sanatorium admission 
and discharge, reason for dis- 
charge and name of sanatorium 
34 whether patient is under public health 
nursing supervision 
date of last nursing visit 
changes in name, marital status, occu- 
pation, place of work 
any items of identification not previ- 
ously known 
b. Clinic records 
(1) Check clinic files against worksheets 
(2) Enter on worksheet 
date of first clinical examination 
diagnosis at first clinical examination 
date of most recent clinic visit 
diagnosis at most recent clinic visit 
last recommendations (treatment, 
hospitalization, supervision) 
dates and results of recent sputum 
report 
c. Laboratory reports 
Check positive sputum reports against 
worksheets 
d. Other records in local health department 
Mass X-ray file for suspects, Selective 
Service rejectee file, consultation films, 
correspondence files. 
4. Private physicians 
a. Query by written form (fig. 11 p. 33), let- 
ter, telephone, or nursing visit for informa- 
tion on patients last reported under physi- 
cian’s supervision 
b. Enter pertinent data on worksheet 
5. Other sources of information 
Tuberculosis Associations 
Office of Vocational Rehabilitation 
Social Service Organizations 
Check worksheets with these sources for 
additional information such as; 
location of patient 
medical supervision 
other agencies interested in family 
C. FINAL STEPS 
1. Review worksheets. Eliminate worksheets for: 
a. cases dead, lost, moved out of State 
b. cases not in need of supervision according 
to State policy 
2. Prepare master index cards (figure 12 p. 38) for 
all remaining worksheets. File cards in one alpha- 
betical sequence. (Keep worksheets in county 
groups for next step.) 
3. Prepare a Record System card for each worksheet 
a. Edit, rearrange and transcribe pertinent 
data from worksheet to Record System 
cards. Keep in county groups 
b. Arrange Record System cards in permanent 
current file by county. 
35 |«Mlf 1| * SWtEKWWL IECJM SYSTEM INSTALLED 
ailGt" »ll»- MAINTAINED? fv>i 
PERSONNEL 
C 
|JP upervisory and clerical personnel responsible for 
installation and maintenance of the State Central 
Record System must be carefully selected. In addi- 
tion to being sufficient in number, personnel must 
be intelligent, well-trained and aware of the objec- 
tives of the State and local tuberculosis programs as 
well as the role of the State Central Record System 
in those programs. 
Supervisory Personnel: Supervision of the Record 
System requires an understanding of the whole tu- 
berculosis program, including techniques of case 
finding, significance of case management and treat- 
ment, and knowledge of the interaction of all agen- 
cies concerned with the total tuberculosis problem. 
Ideally, the Record System should be under the im- 
mediate supervision of the director of the tuberculosis 
control division, for it is he who will be using it as 
an administrative tool. However, since it will be 
impossible in most States for the director to assume 
this added duty, it is recommended that this responsi- 
bility be delegated to a record analyst. The record 
analyst would not only supervise maintenance and 
use of the Record System, but would also be re- 
sponsible for coordination of field reports and out- 
side records. Additional duties of this position might 
entail the preparation of charts, tables and statistical 
analyses from the Record System and other sources. 
Most State civil service or merit systems will have a 
position classification for a statistician or a record 
analyst. In selecting such a person, training in sta- 
tistics, sociology, biology and, if possible, experience 
in the fields of public health or medical statistics 
should be stressed. If no position classification exists, 
one should be developed in cooperation with the State 
civil service or merit system. A sample job descrip- 
tion may be obtained from the United States Public 
Health Service, Tuberculosis Control Division, Wash- 
ington, D. C. 
36 Clerical Personnel: Since the members of the cler- 
ical staff must appreciate the purpose of the Rec- 
ord System and use judgment and discrimination in 
interpreting many types of medical records, they 
must be of the highest caliber. They should be capa- 
ble of efficient and exact performance in detailed 
work. 
The need for Record System personnel will vary 
from Stare to State. Special activities such as indus- 
trial surveys and other mass radiography projects 
will influence the amount of work of the State Cen- 
tral Record System. The number of reports flowing 
to the Record System will, in large part, depend on 
the amount of services rendered by State, local and 
private agencies. Of course, the prevalence of tuber- 
culosis (as evidenced by. morbidity and mortality 
rates) will also have a direct influence on the volume 
of clerical work. In Kansas and Oregon, for example, 
the size of clerical staff needed for work on the Rec- 
ord System varied. Kansas, with a population of 1.7 
million, a mortality rate (1944) of 20 per 100,000 
population, and an annual case reporting rate (1944) 
of 40 per 100,000 population, requires the services 
of a record analyst and one full-time clerk. Oregon, 
on the other hand, with a population of 1.2 million, 
an annual mortality rate of 25 per 100,000 popula- 
tion, and an annual case reporting rate of 5 6 per 
100,000 population, requires a permanent staff of 
one record analyst and two clerks. 
During the installation of the Record System, it 
will be necessary to employ temporary or part-time 
clerks who will not be needed later. Great care 
should be exercised in their selection. It may be pos- 
sible to obtain some temporary personnel by borrow- 
ing within the tuberculosis division of the health 
department. Personnel is, without doubt, the most 
critical factor in the success of the Record System 
plan. Personnel attitudes, interests and abilities will 
directly determine the effectiveness of the Record 
System in the tuberculosis control program. 
DEFINITION OF POLICY 
The State Central Record System has been defined 
as a system of records for maintaining a current sum- 
mary of pertinent medical and public health data of 
known tuberculosis cases and suspects which accord- 
ing to health department policy require some type 
of supervision. Reports from many sources will be 
accepted, rejected or abstracted uniformly only if 
instructions and definitions are clearly stated. Rec- 
ord System personnel need standards in order that 
entries and procedures will be uniform over a period 
of years. This chapter, a working manual for the 
record analyst, is devoted to definitions and specific 
directions for procedures involved in the maintenance 
of the Record System. 
Policy regarding current and closed cases: The 
current file is a file containing a current record for 
every known case or suspect considered "administra- 
tively active” by the head of the State tuberculosis 
office. "Administratively active” cases are those 
under current medical supervision or in need of med- 
ical supervision as defined by State and local policies 
of case management. The definition must be made 
through agreement with the nursing division, local 
health department and sanatoria directors. These 
policies are generally determined by the extent of 
the State and local tuberculosis programs and the 
availability of facilities for service. There undoubt- 
edly will be considerable variation among the States 
37 in definitions of "administratively active” or current 
cases. For example, in a State with limited local 
health organization and a scarcity of public health 
nurses, only the presumably clinically active cases 
will be retained in the current file. Another State 
with more extensive development of local health 
services may retain in the current file known ar- 
rested cases, cases reported as clinically inactive and 
suspects. 
Since all case records will eventually be discharged 
from the current file it is necessary to maintain a file 
for closed case records. This will include cases de- 
fined as not administratively active, such as dead, 
lost or moved out of the State. It may be termed a 
"closed file” and must be kept for two reasons: 
(1) as a source of reference and statistical data, and 
(2) to make case records available for transfer into 
the current file for those which may again become 
administratively active, such as cases returning to the 
State, lost cases which are found and cases with 
reactivation of the disease. 
ORGANIZATION OF FILES 
To make information available for both local and 
State use, 3 files will be necessary. 
1. The current file contains cards on all administra- 
tively active cases. 
Record System cards are grouped in a section 
for each county or other local health jurisdic- 
tion. 
Record System cards are arranged alphabet- 
ically within each county section. 
2. The closed file contains cards for all cases con- 
sidered administratively inactive. 
The cards are arranged by countjy, as in the 
current file, or by alphabetical sequence. 
3. The master index contains a card for every case 
record included in the current file and closed file. 
Arrangement of the current file by county 
sections, plus the existence of a closed file, 
requires the maintenance of a master index 
which will show where the Record System 
card is filed. 
The cards are arranged in one alphabetical 
sequence for entire State. 
Essential items on the master index card are: 
Name 
Location of Record System card—in the current 
or closed file. 
County or city section in which the card is filed. 
Additional identifying information such as year 
of birth, marital status, sex and color to assist in 
locating records and avoiding duplication. 
Figure 12 shows that the card for Mary Doe may 
be found in the "Jackson County” section of the 
current file. 
Figure 12 H 
Figure 12 a. 9 
Figure 12A shows that the card for John Doe may 
be found in the closed file: 
38 INSTRUCTIONS FOR FILLING IN THE RECORD SYSTEM CARDS 
Whenever a first report is received, a card is prepared and inserted in the current file. Information entered 
from first report should be typewritten. Subsequent entries may be in longhand. 
Instructions for filling out the cards are: 
ENTRIES - Identifying data 
Name Last name first in capital letters, followed by first name and middle name or initial. For a mar- 
ried woman enter also maiden name when available. 
COUItty County of residence. 
Number A Record System number can be assigned to each new case reported. A consecutive series, be- 
ginning with number 1, may be maintained for each county. 
39 Address Present home address. Subsequent addresses will be added. After each change of address, indi- 
cate the date. The last entry is present address. Admission to a hospital (other than a mental 
hospital) does not constitute a change in address. 
Birth date Enter month, day and year. If only age is given, compute and enter year of birth. 
Age At the time the case is first reported, enter age at last birthday. 
Sex M or F for male or female. 
Color W for white, N for negro. Designations for other groups should be written out as "Chinese,” etc. 
Marital status . . . Write in full; single, married, widowed, divorced, separated. 
Occupation .... Enter description of specific job: janitor, teacher, miner, carpenter, bookkeeper, student, house- 
wife, etc. DO NOT CONFUSE WITH "place employed.” 
Place employed . . Enter name of company. 
Under public health 
nursing supervision. Enter "yes” or "no.” If there are several agencies in the community, specify whether super- 
vision is from local health department, school, or private nursing organization. State reason for 
no supervision. 
Legal settlement or 
legal residence . . . Check correct block, according to State law. 
Veteran Check yes or no. 
Reason for referral . What prompted the first examination for tuberculosis? Check proper block for reason. 
Date Enter month and year of referral. 
Official morbidity 
report by Specify by name the private physician, clinic, sanatorium, hospital or other source first submit- 
ting an official morbidity report. 
Date Of report . . . Enter date of first official morbidity report. 
40 ENTRIES - Current Status 
Date From report of private physician, clinic or hospital, copy date of examination, (i.e., show date 
of examination—not date information is recorded). When the date of examination is unknown, 
enter date report reached Record System and indicate by an asterisk. Make entries in chrono- 
logical order. 
Diagnosis .... Use the following abbreviations for diagnosis: 
Form of disease Moderately advanced Mod Adv 
Pulmonary Pulm Far advanced Far Adv 
Primary Prim Activity 
Other forms Specify form Active Act 
using abbreviations Questionably active Quest Act 
Stage of disease Quiescent Quies 
Minimal Min Apparently arrested App Art 
41 Arrested Arr Tuberculosis Tbc 
Apparently cured App Cured Suspect Susp 
Inactive Inact Not stated N S 
Healed Heal Questionable ? 
Other abbreviations Probably Prob 
Sputum Positive Pos 
Negative Neg 
No expectoration N E 
Medical supervision . Clinic Name of chest clinic 
Hospital Name of institution and admitted or discharged 
Private physician Name of physician and "MD” 
Out-of-State Specify supervision as above 
plus name of city and State 
Health department H D 
Reported by ... . Specify: 
Clinic Clin Med. discharge from Armed Forces. . . . A F 
Death certificate D Cert Official morbidity report Morb 
General hospital Hosp Private physician Phys 
Interstate referral Int Ref Public health nurse PHN 
Institution other than tbc Tbc sanatorium San 
sanatorium Inst Veterans’ hospital report Vet 
Mass X-ray Mass X Laboratory report Lab 
Remarks . . . . . In the Remarks column enter in abbreviated form all data not applicable to the other columns 
but important for the supervision of the case, such as: application made for hospitalization, rea- 
son discharged, complications, recommendations for treatment, surgery, pneumothorax, discon- 
tinuance of pneumothorax. 
42 ABBREVIATIONS 
Standard abbreviations in general use in your State may be entered in 
the following space: 
43 DATE 
DIAGNOSIS: 
FORM, STAGE,ACTIVITY 
UNDER MEDICAL 
SUPERVISION OF 
REMARKS; REASON NOT 
I ZED, REASON DISCHARGED. ET<fcij 
Wonth 
r NEXT 
REPORT 
IS DUE 
Figure 13 
Sample 
State 
Central 
Record 
Card 
44 
FORM 9423—FEDERAL SECURITY AGENCY—PUBLIC HEALTH SERVICE 
TUBERCULOSIS RECORD SYSTEM—FORM 1, REV 5-46 
18-46609-8 SIGNALING 
One of the advantages emphasized for selecting vertical visible (or offset visible) equipment is that the use of 
signals on the visible margins of the cards facilitates a quick inspection of important summary information. While 
it is possible to summarize a large part of the contents of the Record System cards by marginal signals, it seems 
advisable to limit signaling to information needed for evaluation and maintenance of the Record System. Except 
for periodic counts of summary material, it is not recommended that signals be used for tabulations from the 
cards. The function of the signal is to assist the staff in management; it indicates that some particular action 
must be taken. The suggested plan may be too elaborate or too inclusive. Each health department will make 
its own selection of items to be signaled. When local registers are established, reduction in detail on the State 
Record System can be realized. Statistics are more accurately and easily compiled by hand sorting or machine 
tabulations. 
Specific systems of signaling must necessarily vary among States in order to conform with existing policies 
and organization of services for tuberculosis. Certain important items which will not change could be permanently 
signaled by using a different color card or by stamping a signal on the card. 
For example, in States where race divisions are necessary, one color card might be used for white, a different 
color for negro—or else these two races could be designated by stamping a permanent signal on the margin of the 
card for each non-white patient. 
Likewise all cases found through mass X-ray might be designated by a different color card or by a stamped 
signal on the margin. 
The following is a suggested plan for using marginal signals. According to this plan, signals are used for 
three broad purposes (figure 13). 
1. SUPERVISION: Certain aspects of the supervisory status of cases are important for signaling. They are: 
a. Cases hospitalized 
b. Presumably active or positive sputum cases not hospitalized 
c. Cases under no medical supervision 
d. Cases under clinic supervision 
2. MAINTENANCE: Tickler signals are useful in the mechanics of operating the Record System. They place em- 
phasis on certain cases requiring current action from the record analyst. These signals are reminders which guide 
maintenance. For example, the signal may indicate: 
a. The month that a report on current status is due 
b. The month that additional information is due 
3. REFERENCE: Signals are of value for designating special groups of cases significant for further study or 
statistical analysis. 
a. Suspects 
b. Newly reported cases 
c. Case first reported through mass X-ray 
45 SPECIFIC SIGNALING PLAN 
For signaling purposes the Record System card may be divided into the eight positions represented as follows: 
Figure 13A 
46 MEANING OF SIGNAL 
POSITION 
COLOR 
Supervision and status of cases: 
8 
Blue 
Gase in other institution 
8 
Green 
Positive sputum, case in the home . . 
8 
Red with hole 
Sputum case in the home 
8 
Red 
Sputum negative, case in the home . . 
8 
Brown 
Case under no supervision 
7 
Black 
Case under clinic supervision 
7 
Pink 
Maintenance of Record System 
Month report or query return is due 
January 1 
1 
Red 
February V 1st quarter 
1 
Blue 
March J 
1 
Pink 
April 1 
2 
Red 
May f 2nd quarter 
2 
Blue 
June J 
2 
Pink 
July ] 
3 
Red 
August V 3rd quarter 
3 
Blue 
September J 
3 
Pink 
October 1 
4 
Red 
November }■ 4th quarter 
4 
Blue 
December J 
4 
Pink 
Reference to special groups 
Suspects or probable cases 
Positive sputum—no case report . 
6 
Red 
Mass X-ray suspect 
6 
Brown 
Any other suspect not reported 
6 
Green 
Probable Case; official morbidity report due 
A 
Blue 
New case reported within calendar year 
s 
Pink 
Reported case first discovered by mass X-ray 
s 
Reported case first discovered by clinic 
5 
Green *C 
*Any item which remains constant may be given a permanent signal by use of 
a rubber stamp and colored stamp pad ink. 
47 GENERAL DIRECTIONS FOR MAINTENANCE OF STATE CENTRAL RECORD SYSTEM FOR TUBERCULOSIS: CURRENT 
FILE, CLOSED FILE, AND MASTER INDEX 
FOR ALL REPORTS: Check each incoming report against the master index to learn whether 
▼ a Record System card exists. 
If the master index indicates that there is a card: 
pull it from the current or closed file 
enter new information 
signal 
refile card 
route information to proper persons 
If the master index indicates no card 
search other possible sources of information in the office—(old case index, mass 
survey file, correspondence) 
originate a card from the new report, adding pertinent data previously reported 
signal 
48 prepare master index card 
file card in proper place—if administratively active in the current file, otherwise 
in closed file 
file master index card 
route information to proper persons 
For transfer of cards between current and closed file: 
1. When administratively active case is closed: 
transfer card from current to closed file 
enter on master index card, date and reason for closing 
2. When closed case becomes administratively active: 
transfer card from closed file to current file 
bring master index card up to date 
For change of address: 
1. When a report indicates that a person has moved: 
enter new address on Record card 
49 if new address changes county of residence within the State, 
move card to section for county of new residence. Enter name of new county 
on master index card. 
if new address is out of State, 
1. transfer card from current file to closed file 
2. make proper entries on master index card 
3. prepare interstate reciprocal report form and forward to new State health 
department 
For querying: 
Whenever information reaching the State Central Record System is incomplete 
or inconsistent, query the source of the report for additional information. 
Signal the card to denote the month in which a reply is due. 
When the tickler signal shows that more than 6 months has elapsed since the last 
report on a current case, or that a report was due within the preceding month and 
not received, query the local health department or local physician, or nurses and 
clinics in counties with no health departments. 
For routing information: 
Information reported to the Record System must be forwarded to the health department of the person’s county 
of residence except when the report originated with or was previously routed through that department. The only 
reports which must be kept in the State tuberculosis division are the official morbidity reports and photostats of 
certificates of death from tuberculosis. All other material should be adequately abstracted on the Record System 
card and should no longer be needed for reference. Some reports will be forwarded to local health departments. 
Others coming to the State Central Record System from local health departments can be destroyed. 
50 SPECIFIC REPORTS WHICH FLOW TO THE STATE CENTRAL RECORD SYSTEM AND METHODS OF HANDLING 
Utilizing the foregoing general policies and instructions for procedure, the staff will handle specific reports in 
the following manner: 
1. 
Official morbidity reports. 
A—First report 
1. Enter on new card all available informa- 3. Query the local health department on 
tion: tuberculosis interchange form if no in- 
Name Sex Medical supervision vestigation report is received within 30 
Address Mar. Status Sputum days. 
Age Diagnosis 4. Routing: 
2. Signal month investigation report is due Physician local health depart- 
from county health department or public ment (register) State health 
health nurse, positions 1-4. department (Record System). 
B—Subsequent reports 
Enter on one horizontal line on the card the new information as current status (e.g., date, 
diagnosis, sputum, medical supervision). 
2. 
Clinic reports. 
1. Enter on Record System card, date of examination, diagnosis, results of sputum tests, name 
of clinic and recommendations. Enter only reports of clinical examination. Do not itemize 
successive pneumothorax refills, unless it is planned to use cards as sources of statistical 
tabulations of clinic services. Successive clinic examinations in 6 month or 12 month 
periods that indicate no change in diagnosis or supervisory status could be shown on one 
line by adding only dates of successive exams under "Remarks.” See Chapter 10, "What 
Statistical Data Will the Central Record System Provide?” 
51 2. Signal for month re-examination due, positions 1-4. 
3. Query only in special instances. 
4. Routing: 
a. State clinic State Record System local register 
b. local clinic local register State Record System 
3. 
Public health nursing reports. 
1. Enter new information from Information Interchange Form: 
Patient’s address, change in medical or nursing supervision, change in identifying data, 
name, marital status, occupation or place of employment. When the patient does not 
remain under medical supervision, enter periodically as part of the chronological medi- 
cal history the date and fact of P.H.N. supervision, but show clearly under "Remarks” 
that medical supervision has been refused. 
2. Signal only in special instances when information received is incomplete or inconsistent 
and another report is due. 
3. Query only in special instances. 
4. Routing: 
Public health nurse local register State Record System. 
4 
i • 
Sanatorium reports. 
A—Admission 
1. Enter on one horizontal line date and fact of admission, diagnosis, result of sputum ex- 
amination and name of institution. Between clinic visits the dates and results of sputum 
examination can be added on one horizontal line under "Remarks.” 
2. Signal "case in sanatorium,” position 8. 
3. Query—none, 
4. Routing: 
Sanatorium State Record System local register public health nurse. 
52 B—Discharge 
1. Enter date and fact of discharge, diagnosis, sputum status, name of institution, reason for 
discharge, recommended medical supervision and pertinent remarks such as thoracoplasty 
or pneumothorax. 
2. Signal report from public health nurse regarding current medical supervision due in the 
following month, positions 1-4. 
3. Query if report is not received in one month. 
4. Routing: 
Sanatorium State Record System local register public health nurse. 
5. 
Sputum reports. 
A—Negative reports: Do not initiate Record System cards on basis of negative sputum reports. If card exists, 
1. Enter date, result (including type of examination) and name of physician or agency sub- 
mitting specimen. 
2. Signal—position 8. 
3. Query—none. 
4. Routing: 
Laboratory State Record System- - local register public 
health nurse. 
B—Positive reports: if there is no card, prepare one. 
1. Enter date, result of examination (including type) and name of physician or agency sub- 
mitting specimen. 
2. Signal "Positive sputum case,” position 8, or if no official report has been received "Posi- 
tive sputum—no case report,” position 6. 
3. Query: If no official morbidity report has been received and is not received within two 
weeks, request an official morbidity report from the physician or agency which submitted 
the specimen. 
4. Routing: 
Laboratory State Record System local register public 
health nurse. 
53  
Death reports. 
1. Enter on Record System card date, fact and cause of death, name of physician or institu- 
tion reporting. 
2. Signal—none. 
3. Query: If case has not been previously reported request official morbidity report from 
physician who signed the death certificate. 
4. Routing: 
State vital statistics division State Record System local register 
public health nurse. 
IIP 
Mass X-ray reports. 
Initiate Record System card on the basis of the original small film report. 
1. Enter name and identifying data, date of X-ray, suspected tuberculosis and reported by 
mass X-ray. 
2. Signal: 
(a) "Mass X-ray suspect,” position 6. 
(b) Remove signal when case is reported by official morbidity report or discharged as 
not significant. 
(c) Signal cases reported and left in current file as "Reported Case first discovered 
through mass survey,” position 5. 
3. Query: Whenever no further information is received on a suspect. 
4. Routing: 
X-ray service State Record System f local register f public health 
nurse. 
Other reports. 
General correspondence, interstate reciprocal reports and consultation film reports. 
1. Enter pertinent information. 
2. Signal if report indicates "Probable case—official morbidity report due,” position 6. 
3. Query local health department for official morbidity report from private physician. 
4. Routing: 
Source ► State Record System local register. 
54 HOW IS:A LOCAL REGISTER INSTALLED? 
l«ocalIy, the register serves as a direct guide for 
case management, since the local health department 
has the responsibility for controlling and preventing 
the spread of tuberculosis in the community. Al- 
though the State cooperates with the local health 
department in mass X-ray programs and in the opera- 
tion of sanatoria and clinics, the direct follow-up of 
the cases revealed is usually done by the staff of the 
local health department and by local physicians. 
The foregoing emphasis on a State Record System 
is not meant to minimize the importance of the 
local register. Rather, the State Record System 
stimulate and aid local installations. It ap- 
pears that the establishment of a State Central Case 
Record System with accompanying or later local 
registers is the easiest way to develop uniform local 
case record systems. 
The State Central Record System and the local 
registers follow a similar plan. Each local register 
follows fewer cases but in more detail. The State 
Record System may be considered a complete series 
of local registers. The local register is but an ampli- 
fied section of the State Record System. 
Sources of information, problems of installation 
and maintenance are similar for both. The establish- 
ment in the State division of policy, plans and good 
working gelations with other agencies simplifies many 
problems in the local health department. The direc- 
tor and the record analyst from the State tuberculosis 
division are familiar with these problems and can 
offer experienced assistance to the local health officer 
and supervisory nurse. They will want to become 
acquainted with the plans, mechanics and uses for the 
register; they may welcome assistance in the training 
of clerical personnel. 
The extent of local tuberculosis control facilities 
is not stressed as the criterion for the installation of 
case registers. Even in an area with no clinics and 
inadequate public health nursing service, a register 
will be of considerable assistance in developing a 
program. The incomplete and negative information 
in the register will be an effective argument for ex- 
55 pansion of tuberculosis control service. A local health 
department is ready to install and carry on its regis- 
ter when the following conditions are met: 
1. The local health officer and supervising nurse 
recognize the need for the register, will support 
the plan and use it in their program. 
2. Funds for equipment and personnel are available. 
3. Clerical personnel is available to be assigned as 
needed. 
4. There is active cooperation and interest on the 
part of others in the community who are en- 
gaged in tuberculosis control activities. 
Some local health departments will start their reg- 
isters simultaneously with the installation of the 
State Central Record System. Other local depart- 
ments will wait until the State Record System is 
completed and use it as a nucleus for local installa- 
tion. Presumably through investigation of local and 
other sources, all cases known to the local health 
department will already have been recorded in the 
State Record System with the-ir intermediate and cur- 
rent disease and supervisory status. The director and 
record analyst from the State tuberculosis division 
will consult with local health department personnel 
to acquaint them with the Record System and its 
uses. With the State Central Record System as a 
basis, the two groups may plan for the following 
procedure: 
1. Secure cooperation of the local agencies who will 
be the sources of information or the users of the 
register. 
2. Set up plans for routing through the register all 
reports and information about tuberculosis cases, 
suspects and contacts. 
3. Plan for register card and equipment. The de- 
sign of the local register card should parallel 
that of the State Case Record card. In general, 
the differences between the two will consist of 
more space on the local card for detailed in- 
formation, such as dates re-examinations are due, 
dates of nursing visits and dates and results of 
contact information and contact examinations. 
The local health department may add any other 
details it considers will be useful in case man- 
agement. 
The companies manufacturing the equipment 
discussed in Chapter 4, "What Equipment Is 
Needed?” also manufacture small vertical visible 
units. Portable desk equipment is available for 
case loads from 100 to 1,000. For counties with 
smaller case loads, the book type visible record 
will be more economical and possess the visibility 
of the larger equipment. 
4. Transcribe case summaries from State Case Rec- 
ord cards to local register cards. 
5. Add any recent information from local records. 
Compare with records in local health depart- 
ment to add the details for case supervision not 
entered on the State Record System, such as date 
re-examination is due. Add names and ages of 
contacts, dates and results of examinations and 
dates due for re-examination. 
6. Set up instructions for the local health depart- 
ment for the maintenance of the register. 
56 low ||pl&4 
The local health department is responsible for the 
public health supervision of all cases known to it, 
not only at the time of discovery of the case, but for 
as many years as supervision may be needed to pre- 
vent the spread of disease. The tuberculosis division 
provides the general public health supervision of the 
individual tuberculosis case, delegating the specific 
medical supervision either to a clinic, a sanatorium 
or a private physician, according to the needs and 
preferences of the patient. Through the use of a 
tuberculosis case register, these activities are coordin- 
ated, and centralized supervision of all tuberculosis 
cases can be more easily provided. 
DEFINITION OF THE REGISTER 
A tuberculosis case register is a system of records 
for maintaining a current summary of pertinent 
medical and public health data on those proved and 
suspected cases of tuberculosis which according to 
the health department policy require some type of 
supervision. 
PURPOSES OF THE REGISTER 
1. To direct the public health supervision of all 
tuberculosis cases and suspects, especially those 
who do not keep clinic appointments or do not 
remain under satisfactory supervision. 
2. To aid the health officer or tuberculosis division 
director and the public health nursing supervisor 
in the direction and evaluation of the services of 
their staff. 
3. To serve as a source of reference for information 
about known tuberculosis cases. 
4. To provide the statistical information needed for 
planning and evaluating the local tuberculosis 
control program. 
PERSONNEL 
1. The register is under the direct supervision of the 
director of tuberculosis control or the local 
health officer. 
57 2. One individual must be responsible for keeping 
current information in the register and for main- 
taining the general accuracy and completeness of 
information. In small health departments a clerk 
may be assigned to this position on either a part- 
time or a full-time basis, depending on the size 
of the health department and its activities. In 
larger health departments this responsibility 
should be assigned to a record analyst who has 
training and experience in statistics and report- 
ing methods. 
3. The division director and the public health nurs- 
ing supervisor should be familiar with the sys- 
tem and periodically review case histories from 
the register although the responsibility for main- 
tenance has been delegated to a record analyst or 
clerk. 
EQUIPMENT 
A visible filing equipment (figure 14) which al- 
lows one or more margins of many cards to be visible 
at one time is recommended for ease in locating cards 
and particularly for the advantages of the signaling 
space on the visible margins. Colored signals can 
indicate the supervisory status of the patient and the 
date he should return for a re-examination. This 
insures that cases will not be overlooked or missed. 
REGISTER CARD 
Since this card is patterned after the State Central 
Record card, it too is planned for "vertical visible” 
or "off-set visible” filing equipment. 
Figure 14 
58 The register card is divided into 6 sections: 
Front of the card 
1. Upper 1/3 horizontally lined for identifying 
data and initial information. 
2. Lower 2/3 of card with vertical columns for a 
chronological medical history, including diag- 
nosis, sputum examinations, medical supervision 
and recommendations. 
3. Visible margins with space for signaling super- 
visory status and dates next reports are due. 
Back of the card 
4. Column for dates of home nursing visits to the 
tuberculosis patient. 
5. Section for remarks and information about social 
welfare or related agencies interested in the 
family. 
6. Lower 2/3 for contact data. 
Name, address, identifying data, results of ex- 
aminations and date due for re-examination. 
POLICY FOR REGISTER: Current and Closed File 
Current File: Contains a current record for all cases 
considered by local policy as administratively ac- 
tive—i.e., cases under current medical supervision 
or considered to be in need of medical supervision. 
Closed File: Contains a record for all cases considered 
not administratively active—i.e., cases not in need 
of medical supervision. 
Dead 
Moved out of State 
Lost 
Arrangement of cards in current and closed files: Ar- 
range cards alphabetically by the patient’s surname. 
ENTRIES — Identifying data 
FRONT OF CARD {Figure 15) 
Name Last name first, followed by first name and middle name or initial. For a married woman enter 
maiden name when available. 
County County of residence. 
Number A number can be assigned to each new case reported. A consecutive series beginning with 1 may 
be maintained within the county. 
Address Current home address. Subsequent addresses will be added. After each change of address, indi- 
cate the date. The last entry is present address. Admission to a hospital (other than a mental 
hospital) does not constitute a change of address. 
Birth date Enter month, day and year. If only age is given, compute and enter year of birth. 
59 Age ... At the time the case is first reported, enter age at last birthday. 
Sex M or F for male or female. 
Color .... . . . W for white, N for Negro. Designations for other groups should be written out, as 
"Chinese,” etc. 
Marital status . . . Write in full: single, married, widowed, divorced, separated. 
Occupation .... Enter description of specific job: janitor, teacher, miner, carpenter, bookkeeper, student, house- 
wife. DO NOT CONFUSE WITH "place employed.” 
Place employed . . Enter name of company. 
Under public health 
nursing supervision . Enter "yes” or "no.” If there are several agencies in the community, specify whether super- 
vision is from local health department, school or private nursing organization. State reason for 
no supervision. 
Legal settlement in 
State and in county . Check correct blocks according to State law. 
Veteran Check yes or no. 
Reason for referral . What prompted the first examination for tuberculosis? Check pfoper block for reason. 
Date Enter month and year of referral. 
Official morbidity 
report by Specify by name the private physician, clinic, sanatorium, hospital or other source first submit- 
ting an official morbidity report. 
Date Of report . . . Enter date of first morbidity report. 
60 DATE 
DIAGNOSIS: 
FORM. STAGE.ACTIVITY 
SPUTUM 
UNDER MEDICAL 
SUPERVISION OF 
REPORTEI 
BY 
REMARKS; REASON NOT HOSPITAL- 
IZED. REASON DISCHARGED, ETC. 
MONTH I 
NEXT I 
REPORT I 
IS DUE I 
Form 9423—FEDERAL SECURITY AGENCY—PUBLIC HEALTH SERVICE 
TUBERCULOSISJRECORD SYSTEM—FORM I, REV. 5-46 
61 
Figure 15. Sample Register Card ENTRIES - Current Status 
Date From report of private physician, clinic or hospital, copy date of examination (i.e., show date 
of examination—not date information is recorded). When the date of examination is unknown, 
enter date report reached register and indicate by an asterisk. Make entries in chronological order. 
Diagnosis Enter the form and stage of disease and the activity. Use the following abbreviations: 
Form of disease 
Pulmonary Pulm 
Primary Prim 
Other forms Specify and abbreviate 
Stage of disease 
Minimal Min 
Moderately advanced Mod Adv 
Far advanced Far Adv 
Activity 
Active Act 
Questionably active Quest Act 
Quiescent Quies 
Apparently arrested App Art 
Arrested Arr 
Apparently cured App Cured 
Inactive Inact 
Healed Heal 
Other abbreviations 
Tuberculosis Tbc 
Suspect Susp 
Not stated NS 
Questionable ? 
Probably Prob 
Sputum Positive Pos 
Negative Neg 
No expectoration NE 
Medical supervision Private physician Name of physician 
Hospital Name of institution 
(specify if admitted or 
discharged) (Adm or Disch) 
Name of sanatorium* Abbreviation 
1 1 
2 2 
3 3 
4 4 
Clinic* Name of chest clinic 
Name Abbreviation 
1 1 
2 2 
3 3 
Out-of-State Specify supervision 
as above plus name 
of city and State 
*Fill in names of institutions in your community. 
62 Reported by ... . Who sent the information to the register? Specify: 
Source of report Abbreviation 
Clinic Clin 
Death certificate D Cert 
Hospital (other than Tbc 
Sanatorium) Hosp 
Institution (other than Tbc 
Sanatorium) Inst 
Interstate referral Int Ref 
Mass X-ray Mass X 
Source of report Abbreviation 
Medical discharge from 
Armed Forces A F 
Official mobidity report Morb 
Private physician Phys 
Public health nurse PHN 
Tbc sanatorium San 
Veterans’ hospital report Vet 
Laboratory Lab 
Remarks ..... Enter in abbreviated form all data not applicable to the other columns but important for the 
supervision of the case, such as: 
application made for hospitalization 
complications 
pneumothorax 
reason discharged 
recommendations for treatment 
surgery 
Month report due . Signal the date the next re-examination is scheduled or the date the next information should 
reach the register. 
BACK OF CARD (Figure 15A) 
Other agencies . . . Specify names of social, welfare or related agencies and reason for supervision of case or family. 
Enter date of family’s last contact with agency. 
Date nursing visits . Enter the date of each home nursing visit to the tuberculosis patient. 
CONTACTS 
Name Enter surname followed by first name. 
63 DATES OF 
NURSING 
VISITS 
BIRTH 
DATE. 
SEX. 
COLOR 
NAMES OF CONTACTS 
(ADDRESSES IF DIFFERENT 
FROM THIS CASE) 
REL. 
TO 
CASE 
DATE 
EXAMINED 
DIAGNOSIS 
DATE 
DUE FOR 
RE-EXAM. 
REMARKS 
U. S. GOVERNMENT PRINTING OFFICE 16 46509-3 
64 
Figure 15A. Back of Register Card Relationship to case Abbreviate 
Father F 
Mother M 
Wife W 
Husband H 
Daughter D 
Son S 
Brother B 
Sister Sis 
Aunt A 
Uncle U 
Cousin C 
Niece N 
Nephew Nep 
.Grandfather G F 
In-law L 
Brother-in-law BL 
Stepfather S F 
Year of birth . . . Enter year only 
Sex M for male, F for female 
Color W for white, N for Negro. Abbreviate designations for other groups as Chin, for Chinese, Ind. 
for Indian. 
Date examined. . . Enter date 
Diagnosis Enter Neg for negative if studies indicate that tuberculous infection does not exist or if the only 
evidence of tuberculosis is a positive tuberculin test. 
Obs for observation 
If the diagnosis of tuberculosis is made, use abbreviations given under Diagnosis on page 62 on 
the front of the card. 
Specify whether the examination was by tuberculin, fluoroscope or X-ray. 
Date due for re-exam Enter date as recommended by physician. 
Remarks Enter the source of the medical supervision such as the name of clinic or private physician. 
SIGNALS 
b. Cases under the supervision of the private 
physician who should be queried during 
the month 
c. Cases on whom some follow-up informa- 
tion is due 
3. Special groups of cases significant for further 
study or statistical analysis. 
a. Suspects 
b. Newly reported cases 
c. Cases first reported through mass X-ray 
Use to indicate: 
1. Supervisory status. 
a. Cases hospitalized 
b. Presumably active or positive sputum cases 
not hospitalized 
c. Cases under no medical supervision 
d. Cases under clinic supervision 
2. Cases requiring current action each month, 
a. Cases which should return to clinic 
65 SPECIFIC SIGNALING PLAN . 
MEANING OF SIGNAL 
POSITION 
COLOR 
Supervision and status of cases: 
Case in sanatorium 
8 
Blue 
Case in other institution _ . .... 
8 
Gmen 
Positive sputum case in the home 
8 
Red with hole 
Sputum unknown in the home 
8 
Red 
Sputum negative case in the home _ _ 
8 
Brown 
Case under 
no suoervision 
7 
Black 
Case under clinic supervision - 
7 
Pink 
Maintenance of register: 
Month examination 
due or further information due 
January 1 
1 
Red 
February >■ 
1st quarter 
1 
Blue 
March J 
1 
Pink 
April 1 
2 
Red 
May > 2nd quarter 
2 
Blue 
June J 
2 
Pink 
July 
3 
Red 
August 
- 3rd quarter 
3 
Blue 
September 
3 
Pink 
October 
4 
Red 
November 
- 4th quarter 
4 
Blue 
December 
4 
Pink 
Reference to special groups: 
Suspects 
Positive sputum—no case report 
6 
Red 
Mass X-ray suspect _ - 
6 
Brown 
Any other suspect not reported _ - 
6 
Green 
Probable case, official morbidity report due 
* 
Blue 
New case reported within calendar year ... , .... 
•> 
Pink 
Reported case first discovered by mass X-ray _ _ 
5 
Brown M* 
Renorted ease first discovered bv clinic 
s 
Creen C* 
Any item which remains 
constant may be given a permanent 
ignal by use o: 
a rubber stamp and colored 
stamp pad ink. 
The visible margin may be divided into the eight signaling positions. 
66 GENERAL DIRECTIONS FOR ENTRIES IN THE REGISTER; Current File and Closed File 
Change of address: 
A—Enter new address on register card 
B—When a report indicates that a person has 
moved outside the county, transfer card from 
current to closed file 
C—Notify State Record System of change of ad- 
dress on tuberculosis interchange form (figure 
5, page 24) 
For querying: 
A—Whenever information reaching the register 
is incomplete or inconsistent, query the source 
of report for additional information. Affix a 
signal to the register card and denote the month 
in which a reply is due (Signal position 1-4). 
The tuberculosis interchange form can be used 
to query local nurses or the State Record 
System. 
B—When more than 6 months have elapsed since 
the last report on an administratively active 
case under the supervision of a private physi- 
cian, query private physician for current status 
of patient. Telephone call or nursing visit may 
be used to request information from private 
physician. 
SPECIFIC REPORTS WHICH FLOW TO THE 
REGISTER AND METHODS OF HANDLING 
1. Official morbidity reports made by the private physician, clinic 
physician, hospital physician or the local health department to 
report the existence of a case of tuberculosis. 
a. When first report is received, prepare and file 
a new card, using available information. Use 
standard abbreviations for diagnosis (see page 
62). 
For each report: Check each incoming report against 
the current file and the closed file to learn whether 
a register card exists. 
A—If there is a register card: 
1. pull from file 
2. enter new information 
3. signal 
4. refile register card 
5. route report to proper persons 
B—If there is no register card: 
1. search other possible sources of information 
in the office—(old case index, mass survey 
file, correspondence) 
2. originate a register card from the new re- 
port, adding pertinent data previously re- 
ported 
3. signal 
4. file register card in proper place—current 
or closed file 
5. route report to proper persons 
For transfer between current and closed file: 
A—When an administratively active case is closed, 
transfer card from current to closed file (dead, 
moved, lost, not significant for further follow- 
up) 
B—When a closed case becomes administratively 
active, transfer card from closed file to the 
current file (lost case which has been found 
or cases which have moved back to the com- 
munity) 
67 b. Signal card indicating the month an investi- 
gation report is due from public health nurse 
(Signal position 1-4). 
If no report in 2 weeks, send query on tuber- 
culosis interchange form to nurse. 
c. If there is already a register card for case, 
enter the new information as current status 
in one horizontal line on the card. 
d. Report is routed from physician ► local 
health department (case register) State 
health department (State Central Record 
System). 
2. Clinic reports 
a. Enter on the register card, date of examina- 
tion, diagnosis, results of sputum tests, name 
of clinic and recommendations. (Use abbre- 
viations on pages 62, 63.) On reverse of card 
enter date and result of contact examination. 
b. Enter reports of clinical examinations. 
Itemize dates of successive pneumothorax re- 
fills under "Remarks” on same line as last 
clinical examination. 
c. Signal indicating "Month next report is due,” 
positions 1-4. 
d. Routing of report: 
1. local health department clinic ► local 
register ►State Record System, or 
2. State clinic ——►State Record System 
► local register 
3. Public health nursing report 
a. Enter on register card date of each public 
health nursing visit to the tuberculosis patient 
and any new information or change of in- 
formation. This may consist of movement of 
patient, change in medical or nursing super- 
vision or change of identifying data, such as 
name, marital status, occupation or place of 
employment, examination of contacts. 
b. In small centralized health departments the 
nursing record can be routed through the reg- 
ister after each home visit. The date of nurs- 
ing visit and changes of information can be 
entered on the register by the clerk. 
c. In large health departments the nurse will 
probably inform the register of new informa- 
tion or change of information on the tuber- 
culosis interchange form. Record of home 
nursing visits can be secured for the register 
from the daily record sheet of each nurse. 
After the sheets have been used for statistical 
tabulation, they can be routed weekly or 
monthly through the register. 
d. Information is routed by means of a tuber- 
culosis interchange form. Public health 
nurse ► register State Record 
System. 
4. Hospital admission and discharge reports 
a. Admission: Enter on one horizontal line the 
date and fact of admission, diagnosis, result of 
sputum examination and name of institution. 
b. Discharge: Enter same data plus reason for 
discharge and recommended supervision. 
Affix signal indicating the month the next 
report is due, Signal position 1-4. 
c. Routing of hospital reports: 
Hospital ► State Record System ► 
local register ► public health nurse. 
68 5. Sputum reports 
a. Negative reports: Enter on register card the 
date, result of examination—including type 
of examination—and name of physician or 
agency submitting specimen. 
b. Positive reports: Enter information as above. 
If there is no case record in the register, pre- 
pare a register card. 
Affix signal indicating "Positive sputum—no 
case report,” Signal position 6. 
After two weeks, request an official morbidity 
report from the physician or agency which 
submitted the specimen. 
c. Routing of reports: 
Laboratory State Record System —► 
register f public health nurse. 
6. Death reports 
a. Enter on register card fact and cause of death 
and name of physician or institution. 
b. If no register card exists, prepare one from 
the information on the death report and place 
the card in the closed file. 
Request official morbidity report from physi- 
cian who signed the death certificate. 
Send interchange form to public health nurse 
to initiate contact examinations. 
c. Routing: 
Vital statistics division State Rec- 
ord System ► register public 
health nurse. 
7. Mass X-ray reports 
a. Start register cards for all suspects on the 
basis of the small film reading. 
Make subsequent entries from the reports of 
the 14"x 17" follow-up film, clinical exam- 
inations and nursing visits. 
b. Signal "Mass X-ray suspects” (Signal posi- 
tion 6) for attention, until the suspect is offi- 
cially reported as a tuberculosis case or as 
not significant for further supervision. 
69 WHAT STATISTICAL DATA Will THE STATE CENTRAL 
RECORD SYSTEM PROVIDE? 
|n addition to serving as a case-holding device, the 
Central Record System offers an opportunity to 
assemble and analyze data for general administration 
of the State and local tuberculosis programs, and for 
research in the epidemiology of tuberculosis. Statis- 
tics to be used by the administration for consultation 
and guidance to local health departments, in direct 
case management and program planning, can be sum- 
marized from the State Record System whenever 
needed. These statistics can further serve as a source 
of most of the data required by U. S. Public Health 
Service for semi-annual and annual reports. 
The State tuberculosis director requires a knowl- 
edge of the total State tuberculosis problem to direct 
the allocation and expenditure of funds and services. 
He must be able to evaluate the results of services in 
terms of cases brought under public health nursing 
supervision, cases hospitalized and cases receiving 
clinic service. All this information is available from 
the Central Case Record System. 
Quantitative measures of total services furnished 
by public health nurses and clinics to tuberculosis 
cases cannot be obtained from the State Record Sys- 
tem without provision for additional details on the 
cards. The record of services to contacts and sus- 
pects, an important part of tuberculosis control 
programs, will also not be available from the State 
Record System. These statistics in most instances 
must originate from direct compilations of the serv- 
ices of each clinic and public health nursing division. 
While it may not be practical to analyze certain 
information from the State Record System because 
of incomplete or unreliable reporting, the need for 
basic tabulations on new cases, case loads, and deaths 
is evident. Certain of these tabulations may be 
planned in advance and will be of use even though 
the raw data are incomplete. Some will be assembled 
as needed and will be merely hand counts to give 
particular indices. Information such as geographic 
distribution of cases and deaths may be tabulated 
70 each month, while more detail of the status of the 
known case load will be tabulated annually or semi- 
annually. 
The method employed to tabulate these data will 
vary according to the size of the State Record Sys- 
tem and the equipment and personnel of the tubercu- 
losis division and the State health department. For 
small Record Systems containing less than 1,000 
cases, it will be possible to hand-sort the cards for 
the necessary statistics. The vertical visible filing 
equipment simplifies the process of pulling and re- 
filing the cards so that the cards can be pulled from 
the file and easily hand-sorted and counted according 
to any classification desired. However, even for small 
installations it will be worthwhile to consider the 
use of auxiliary punch cards of a simple design to 
obtain annual or semi-annual tabulations. 
Machine tabulation is usually needed to compile 
sufficient statistics on a semi-annual or annual basis 
from a record system of more than 1,000 cases. Ac- 
curacy and economy of effort result. 
METHODS OF MACHINE TABULATION 
Any State tuberculosis division planning to obtain 
statistics from the Record System by using punch 
card equipment must decide whether (1) to main- 
tain a statistical punch card file as current as the 
Record System or (2) to punch the whole Record 
System periodically whenever tabulations are planned 
(i.e., semi-annually or annually). The first means 
re-punching the statistical card each time new in- 
formation on the case comes to the Central Record 
System. This is a large additional clerical job. The 
second is a simpler clerical operation; this will call 
for the complete re-punching of the Record System 
material annually or semi-annually. The obvious dis- 
advantage is that original and current status of 
cases is indicated only at a given time. 
After practical experience in the field with both 
methods, it became evident that the first plan was 
cumbersome and could work only in a State with 
excellent facilities for statistical operations. Even 
then, it was doubtful whether the value gained from 
this method would warrant the expenditure of the 
extra funds needed for its maintenance. The second 
plan works well and is relatively simple. In this 
chapter are presented a punch card code and sug- 
gested tables which will make available statistics on 
new cases and suspects, current case load, and mor- 
tality. A brief description of each of the tables 
follows: 
Tables I. A, B, C 
Summary statistics for case management. 
State Central Record System personnel should be 
ready, at any time, to supply summaries of informa- 
tion for local areas. The director of the tuberulosis 
division or State consultant nurses may request this 
information to be used for consultation and guidance 
in field work with local health departments. Basic 
data can be quickly hand tallied from the county 
section of the Record System. Some of these are: 
Table! A 
Current Status of Cases and Suspects. 
Listings, by name, of cases needing discussion and 
review. 
Examples: 
1. Cases discharged from nursing service 
2. Cases under no medical supervision 
3. Cases with no record of a recent examina- 
tion 
4. Positive sputum cases or active cases not 
hospitalized 
Cases and Suspects by status 
1. Tuberculosis cases in current file 
a. Cases in sanatoria 
b. Cases in other institutions 
2. Suspects in current file 
71 3. Mass X-ray suspects by current status 
a. Reported as cases 
b. Reported as not tuberculosis 
c. No report received 
Table I B 
Probable activity of disease for cases not hos- 
pitalized. 
Table I C 
Type of current medical supervision for cases not 
hospitalized. 
Tables II. A, B, C 
Current morbidity reports. 
An analysis of the characteristics of newly re- 
ported cases, monthly and annually, will serve as a 
measure of the effectiveness of case finding activities 
in tuberculosis control. These data collected over a 
period of years can be used to determine trends in 
case finding and reporting. Variables important in 
the analysis of the new morbidity reports are: geo- 
graphic distribution, the source of the report, stage 
of disease, age, sex and color. 
Table II A 
Newly reported cases by county or city of resi- 
dence and by form and stage of disease. 
When the geographic distribution of new cases and 
deaths is available, it is possible to compute the ratio 
of new cases to deaths in a given area. This is often 
used as a measure of the adequacy of case finding 
methods. The classification of new cases by stage 
of disease and county of residence will point out the 
areas reporting tuberculosis only in its advanced 
stages. 
Table II B 
Newly reported cases by form and stage of disease 
and source of report. 
This is a particularly useful table since it not only 
tells who are discovering and reporting new cases 
(i.e., private physicians, health departments, clinics, 
etc.) but also indicates the sources which are dis- 
covering tuberculosis in its early stages. 
Table II C 
Newly reported cases by form and stage of disease 
by age, sex and color. 
Distribution of tuberculosis cases by age, sex, and 
color is information necessary for direction of serv- 
ices of case finding and case management. 
COUNTY POPULATION 
(STATE) 
A. Listing, by name, of cases needing discussion or review 
B. Cases and Suspects by Status: 
1. Tuberculosis Cases in Current File 3. Mass x-ray suspects 
” a. Cases in sanatoria By disposition status 
b Cases in other institutions a Reported as cases 
b. Reported as not tuberculosis 
2. Suspects in Current File c No disposition report received ____ 
TABLE 
I A 
PROBABLE ACTIVITY BY TYPE OF SUPERVISION FOR CASES IN CENTRAL RECORD 
SYSTEM NOT HOSPITALIZED 
PROBABLE ACTIVITY 
TOTAL 
CLINIC 
UNDER 
PHN 
TYPE OF SUPERVISION 
NO 
PHN 
PR. PHYSICIAN 
UNDER 
PUN 
NO 
PHN 
NONE 
UNDER 
PUN 
NO 
PUN 
TABLE 
IB 
TOTAL 
POSITIVE SPUTUM 
OTHER ACTIVE OR 
PRESUMABLY ACTIVE 
OTHER CASES 
TYPE OF 
SUPERVISION 
TOTAL 
Report within 
fc months 
t-11 months 
12-23 months 
TABLE 
I C. 
TOTAL 
CLINIC 
HEALTH 
DEPARTMENT 
PRIVATE 
PHYSICIAN 
NONE 
72 Tables III. A, B, C, D 
Current Analysis of Record System. 
Neither incidence nor mortality data as collected 
in State health departments gives a complete picture 
of the total known State tuberculosis problem. The 
State Tuberculosis Record System can be the source 
of more information. Possible tabulations and their 
uses are too numerous to discuss in a manual. There 
are some, however, that should be set up routinely 
from any State Record System; and some which will 
serve as bases for annual or semi-annual reports. They 
pertain to the geographic distribution of cases, clin- 
ical status and types of supervision. 
The State health department needs to know the 
geographic distribution of the case load and its char- 
acteristics. To evaluate and plan for services, analyses 
by clinical status and by type of supervision (i.e., 
the number of active, presumably active, or inactive 
cases under the supervision of private physicians, 
health department clinics, sanatoria, or under no 
supervision) will be valuable. The number of pre- 
sumably active or positive sputum cases not hospital- 
ized may be an indication of a need for added sana- 
torium facilities. Age, sex and color distributions of 
the case load may further define the problem. To 
include these factors, the following tables are sug- 
gested for geographic subdivisions and for the total 
State. 
Table ill A 
Cases by age, sex and color, and by form and stage 
of disease. 
Table III B 
Cases by current medical supervision and probable 
activity. 
TABLE II A 
NEWLY REPORTED CASES OF TUBERCULOSIS BY RESIDENCE OF CASE AND 
BY FORM AND STAGE OF DISEASE 
Geographic Area 
(County or City) 
TOTAL 
FORM AND STAGE OF DISEASE 
REINFECTION TUBERCULOSIS 
NOT 
STATED 
PRIMARY 
Minimal 
Mod. 
Advanced 
Far 
Advanced 
Stage 
Not Stated 
Other 
forms 
TOTAL 
TABLE 11 B 
NEWLY REPORTED CASES OF TUBERCULOSIS BY FORM AND STAGE OF DISEASE 
AND SOURCE OF REPORT 
Form and Stage of 
Disease 
TOTAL 
Source of Report 
Private 
Phys. 
Health 
Dept. 
Clinic 
Sanatorium 
Other 
Instit. 
Other 
Other 
TOTAL 
REINFECTION 
TUBERCULOSIS 
Minimal 
Mod. Advanced 
Far Advanced 
Stage not stated 
Other Forms 
Not Stated 
Primary 
TABLE 11 C 
NEWLY REPORTED CASES OF TUBERCULOSIS BY FORM AND STAGE OF DISEASE 
BY AGE, SEX AND COLOR 
WHITE 
FORM AND STAGE OF DISEASE 
REINFECTION TUBERCULOSIS 
AGE Total Minimal .Mod Far Staje Other Stated Primary 
Advanced Advanced not stated forms 
MFMFMF MF M FMIFMFMF 
TOTAL 
UNDER 5 YEARS 
5-14 
15-24 
25-34 
35-44 
45-54 
55-64 
NONWHITE 
FORM AND STAGE OF DISEASE 
REINFECT ION TUBERCULOSIS 
irt —i N<)t 
Total Minimal . .Mod- ..Far . S'**' . ,°ther Stated Primary 
Advanced Advanced not stated forms 
MF MFMF MF M FMiFMFMF 
TOTAL 
UNDER 5 YEARS 
5-14 
15-24 
25-34 
35-44 
45-54 
55-64 
73 Table ill C 
Cases by current medical supervision and the in- 
terval since last report was received. 
Table III D 
Cases by reason referred and current medical su- 
pervision. 
Additional tabulations. 
From other information on the card, counts may 
be made periodically or whenever needed. These 
would include, for administrative purposes, items 
such as: 
1. Number of veterans reported as cases 
2. Number of cases without legal residence in the 
State 
3. Number of positive sputum cases not officially 
reported. 
TABLE 111 B 
CASES BY CURRENT MEDICAL SUPERVISION AND PROBABLE ACTIVITY 
ACTIVE OR QUESTIONABLY ACTIVE OTHER 
CURRENT MEDICAL 
SSKf S. JSSJJi, ««••"« i 
TOTAL 
PRIVATE PHYSICIAN 
HEALTH DEPARTMENT 
TUBERCULOSIS CLINIC 
Tuberculosis Sanatorium 
OTHER HOSPITAL 
OTHER INSTITUTIONS 
OTHER 
NOT STATED 
TABI.K NIC 
CASKS BY CIRREM MEDICAL SI PERV LSION \\l) THE INTERV AL SINCE LAST REPORT 
TIME INTERVAL SINCE LAST REPORT RECEIVED 
Cl RRKNT MEDICAL — — j— 
SI PER VISION TOTAL Tmonths «*-•• months 12-1.1 mo. 
TOTAL 
PRIV ATE PHYSICIAN 
Tt BERCLLOSES CLINIC 
OTHER HOSPITAL 
OTHER 
TABLE III A 
CASES BY ACE. SEX \NI) COLOR AND BY FORM AND STAGE OE DISEASE 
WHITE 
FORM AND STAGE OF DISEASE 
REINFECTION IT BERCl LOSIS 
AGE Total Minimal . .Mod' Ear M Stage Other Not Primary 
Advanced Advanced not stated forms Stated ' 
memIfm f mf m f mfmf mf 
I ruler 5 Years 
NON WHITE 
FORM AND STAGE OF DISEASE 
REINFECTION i t BERCl LOSIS 
Total Minimal Advanced Advanced not* stated forms Stated Primar>' 
TOTAL 
I'nder 5 Years 
65 and over 
—L_ 1 1 
TABLE III D 
CASKS BY REASON REFERRED AND Cl RRENT MEDICAL SUPERVISION 
CURRENT MEDICAL SUPERVISION 
REASON REFERRED , , Private Health .... Tbc. Other Other ... Not 
PIIVS. dept "*C San. Ilosp. In»t. (Mher None Stated 
MASS X-RAY 
INTERSTATE REFERRAL 
CONTACT 
SYMPTOMS 
74 Tables IV. A, B, C 
Analysis of the closed file. 
Cases discharged from the current file to the closed 
file provide information essential for evaluation of 
the tuberculosis program and services. For the most 
part, these cases will be dead, moved out of State, 
healed, lost or defined as administratively inactive.* 
Significant statistics for cases closed each year are 
the following: 
Table IV A 
Reason discharged from current file by length of 
time in current file. 
Table IV B 
Tuberculosis deaths by form of disease, age, sex 
and color. 
Table IV C 
Tuberculosis deaths by county of residence and in- 
terval since first report. 
TABLE IV A 
CASES OF TUBERCULOSIS BY 
REASON DISCHARGED FROM CURRENT FILE BY LENGTH OF TIME IN CURRENT-FILE 
LENGTH OF TIME IN CURRENT FILE 
REASON FOR DISCHARGE Under fc ,, mo 12 mo 24 J5 mo i 5 yr byT‘ 
TOTAL 
INACTIVE TUBERCULOSIS 
(not significant for 
DEAD 
MOVED OIT-OF-STATE 
NON-TUBERCULOUS 
OTHER 
Table IV A 
TABLE IV B 
DEATHS BY FORM OF DISEASE. AGE. SEX. AND COLOR 
WHITE 
FORM OF DISEASE 
TOTAL (all forms PI l.MONARY OTHER FORMS 
TOTAL 
I'nder 5 Years 
5-14 
15-24 
25-34 
35-44 
45-54 
55-64 
65 years and over 
NON-WHITE 
w:l lOTAI. iall forms Pi l.MONARY' OTHER FORMS 
TOTAL 
Lnder 5 Years 
Table IV B 
Table IV C 
TABLE IV C 
HBKRCIIOSIS DKVUIS »V TIMK INTKRX \l. BKIWF.F.N 11 RKK< 1 I.OSIK CASK KKPORT 
AND DKATII. BY COI STY 
Time interval between case report and death 
(.'.unry TM- 1 „,l„ . .1 j t to n itj 
TOTAL 
Case* first reported hy death certificate orJ>> morbidity report simultaneously 
*See chapter VII, "How Is A State Central Record System 
Installed and Maintained?” p. 3 6. 
75 Another use of the Central Record System is to furnish data necessary for the semi-annual and annual reports 
requested by the U. S. Public Health Service. A copy of each report is reproduced below (figures 16 and 17). 
FORM 
Federal Security Agency 
Public Health Service 
Tuberculosis Control Div. 
SEMI - ANNUAL 
TUBERCULOSIS REPORT 
State or City 
Six-months' Period Ending 
SPONSORED ~BY~ 
PROJECT FINDINGS TOTAL Official Private 
agencies agencies 
A. Number of individuals reported examined in Mass Radiography Projects... 
Total number of individuals with films characteristic of reinfection 
' tuberculosis (By Stage of Disease) 
1. Minimal 
2. Moderately advanced 
3. Far advanced 
4. Stage unknown 
Number of morbidity reports received this period for cases first dis- 
c* covered by Mass Radiography Projects 
I. MASS RADIOGRAPHY PROJECTS 
SEMI-ANNUAL 
TUBERCULOSIS 
REPORT 
n. MORBIDITY 
A. Total tuberculosis cases newly reported during this period (By Source of Report) 
1. Private physicians 
2. Tuberculosis sanatoria and general hospitals 
3. Public and private chest clinics 
4. Mental institutions 
5. Death certificates 
6. Other 
FIGURE 16 
B. Race and sex of newly reported cases 
Total 
1. White 
2. Non-white 
TOTAL 
Male Female 
HI. MORTALITY 
Provisional number of tuberculosis death certificates coded nos. 13-22 inclusive* by 
A. State Vital Statistics Division for this six-months’ period (By Place of Occurrence) 
♦International List of Causes of Death 
Remarks 
76 It will be found that most of the material required 
for the semi-annual summaries, and part of that for 
the annual, can be obtained from the suggested 
tabulations: 
SEMI ANNUAL TUBERCULOSIS REPORT 
I. Mass Radiography Projects 
Item A. Obtain from units operating in the area. 
Item B. Count all vertical visible register cards 
prepared during the six-month period for 
all individuals whose reports from mass 
radiography units show films characteristic 
of reinfection tuberculosis, regardless of 
whether follow-up examinations have been 
made or not. Such individuals will ordi- 
narily be classified as suspects until fol- 
low-up examinations have been completed 
or 
Obtain from Mass Radiography Project 
Analysis Reports from all units operating 
in the area. 
Item C. Hand sort record cards or 
Use columns 21 through 23 of the sug- 
gested codes for punch card system. 
Count those tuberculosis cases newly re- 
ported during the six-month period re- 
gardless of the date they were found in 
mass radiography services as tuberculosis 
suspects or as having films characteristic 
of reinfection tuberculosis. 
II. Morbidity 
Item A. Hand sort record cards for month and 
year of initial report or 
Use columns 13, 14 and 15 of Code. 
Item B. Hand sort for race and sex or 
Use columns 9 and 10 Code. 
III. Mortality 
Item A. Obtain information from Vital Statistics 
Division 
ANNUAL TUBERCULOSIS REPORT (Figure 17) 
IV. Chest Clinic Services 
Item A. Count record cards or 
Obtain statistical reports from each clinic 
in the State. 
Item B. Count record cards or 
Obtain statistical reports from each clinic 
in the State. 
Items C and D. Obtain from clinic records unless 
record cards are planned to include such 
detail. 
V. Public Health Nursing Services 
Items A and B. Obtain from local registers or 
nursing records. 
PUNCH CARO SCHEDULE 
Identification 
1-2 County or city of residence 
5-6 Case number 
7-8 Year of birth 
9 Sex 
10 Color 
11 Length of residence in State 
12 Veteran status 
Original Report 
13-14 Month and year of report 
77 ANNUAL TUBERCULOSIS REPORT 
FORM 
Federal Security Agency 
Public Health Service 
Tuberculosis Control Div. 
ANNUAL 
TUBERCULOSIS REPORT 
STATE or CITY YEAR ENDING 
December 31, 194 
IV. CHEST CLINIC SERVICES 
CLASSIFICATION TOTAL 
—- Total number of clinic cas'es of reinfection tubercu- 
‘ losis diagnosed for the first time during year 
1. Minimal 
2. Moderately advanced 
3. Far advanced 
4. Reinfection tuberculosis (Stage Not Specified).... 
Total probably active 
1. Minimal (Probably Active) 
2. Moderately advanced (Probably Active) 
3. Far advanced (Probably Active) 
. Reinfection tuberculosis (Stage Not Specified 
But Probably Active) 
WHITE NON-WHITE 
Under 15 years Under 15 years 
15 years and over 15 years and over 
FIGURE 17 
Number of previously diagnosed reinfection 
cases given clinic service during year 
Total clinic services given during year to all 
persons included under (A) and (B) 
D, Pneumothorax Service 
1 Number of patients given pneumothorax during 
year 
Number of pneumothorax refills and other ser- 
’ vices given during year 
V. TUBERCULOSIS PUBLIC HEALTH NURSING SERVICES 
A. Total number of tuberculosis cases which were given home nursing service during this year 
1. Cases admitted to home nursing service for first time 
2. Cases first admitted to home nursing service during previous years 
B. Total number of visits for tuberculosis made by home nursing service 
Remarks 
78 7-8 Year of birth 
Numerical—last two digits of year 
Example: 99 . . . 1899 
00 . . . 1900 
35 . . . 1935 
9 Sex 
1 . . . Male 
2 . . . Female 
X. . . Not stated 
10 Color 
1 . . . White 
2 . . . Negro 
3 . . . Mexican 
4 . . . Indian 
5 . . . Oriental (Chinese, Japanese, 
Filipino) 
9 . i . Other 
X . . . Not stated 
11 Length of residence in state 
1 . . . Under 1 year 
2 ... 1 year and over 
X. . . Not stated 
12 Veteran status 
1 . . . Veteran 
2 . . . Non-veteran 
X. . . Not stated 
13-14 Morbidity (Month and Year of 
Original Report) 
13 Month 14 Year 
1 . . . January Punch last digit 
2 . . . February of year. 
3 . . . March 
4 . . . April 
5 . . . May 
6 . . . June 
15 Source of report 
16-17 County or city of residence at time 
of original report 
18 Stage of disease 
19 Clinical status 
20 Sputum status 
21 Reason referred 
22-23 Month and year of original report 
Current Status 
24 Interval since last report 
25 Stage of disease 
26 Clinical status 
27 Number of clinic visits 
28 Sputum 
29 Supervision 
30 PHN 
Closed File 
31-32 Date discharged from current file 
3 3 Reason discharged 
34 Interval between official report and 
discharge from current file 
PUNCH CARD CODE 
Column 
1-2 County or city of residence 
01 . . . Auburn 
02 . . . Baker 
03 . . . Clackamas 
3-6 Case number 
Numerical 
Example: 0001 
0002 
0003 
79 7 . . . July 
8 . . . August 
9 . . . September 
0 . . . October 
X . . . November 
Y . . . December 
15 Source of official morbidity report 
1 . . . Private physician 
2 . . . Local health department 
3 . . . Clinic 
4 . . . Tuberculosis sanatorium 
5 . . . Other hospital 
6 . . . Mental institution 
8 . . . Death certificate 
9 . . . Other 
X . . . Not stated 
16-17 County or city of residence at time 
of original report 
Same code as for columns 1-2 
18 Stage of disease on original report 
1 . . . Minimal 
2 . . . Moderately advanced 
3 . . . Far advanced 
4 . . . Advanced, not specified 
5 . . . Pulmonary, stage not stated 
6 . . . Primary 
9 . . . Other forms 
X . . . Not stated 
19 Activity and clinical status 
1 . . . Active 
2 . . . Probably active 
3 . . . Questionably active or activi- 
ty undetermined 
4 . . , Inactive 
6 . . . Quiescent 
7 . . . Apparently arrested 
8 . . . Arrested 
9 . . . Apparently cured or healed 
X . . . Not stated 
20 Sputum status at time of original 
report 
1 . . . Positive 
2 . . . Negative 
9 . . . No expectoration 
X. . . Not examined 
21 Reason referred 
1 . . . Symptoms 
2 . . . Contact 
3 . . . Mass x-ray 
4 . . . Selective Service 
5 . . . Army or Navy Discharge 
6 . . . Veterans Hospital 
7 . . . Interstate referral 
8 . . . Positive sputum 
9 . . . Other 
X. . . Not stated 
22-23 Month and year of original referral 
22 Month 23 Year 
1 . . . January Punch last digit 
2 . . . February of year 
3 . . . March 
4 . . . April 
5 . . . May 
6 . . . June 
7 . . . July 
8 . . . August 
9 . . . September 
0 . . . October 
X. . . November 
Y . . . December 
24 Interval since last report 
1 . . . Less than 6 months 
80 2 . . . Less than 6 months, initial 
report only 
3 ... 6-11 months 
4 . . . 6-11 months, initial report 
only 
5 ... 1 year 
6 ... 1 year, initial report only 
7 ... 2 years and over 
8 ... 2 years and over, initial report 
only 
25 Stage of disease, current 
Same code as for column 18 
26 Clinical status, current 
Same code as for column 19 
27 Number of clinic visits during inter- 
val (This will be available only when 
all clinic visits are recorded) 
0 . . . None 
1 . . . One 
2 . . . Two 
(Space) 
9 . . . Nine or more 
X. . . No report 
28 Sputum, current 
1 . . . Positive 
2 . . . Negative 
X . . . Not stated 
29 Supervision 
0 . . . None 
1 . . . Private physician 
2 . . . Local health department 
3 . . . Clinic 
4 . . . Tuberculosis sanatorium 
5 . . . Other hospital 
6 . . . Mental institution 
9 . . n. Other 
X. . . Not stated 
3 0 PHN Supervision 
1 ... Yes 
2 ... No 
X . . . Not stated 
31-32 Date discharged from current file 
Numerical—last two digits of year 
3 3 Reason discharged 
1 . . . Arrested or apparently cured 
2 . ; . Dead 
3 . . . Lost 
4 . . . Moved out of state 
5 . . . Old primary 
6 ... Non tuberculous 
9 . . . Other 
X . . . Not stated 
34 Interval between first official report 
and discharge from current file 
0 . . . None 
1 . . . Under 3 months 
2 . . . 3-5 months 
3 ... 6-11 months 
4 . . . 12-23 months 
5 . . . 24-35 months 
6 . . . 3-5 years 
7 ... 6 years and over 
81 GLOSSARY 
Administratively Active Cases 
Cases under current medical supervision or in 
need of medical supervision as defined by State 
and local policies of case management. 
Annual Tuberculosis Report 
A summary report of chest clinic and tubercu- 
losis public health nursing services to be re- 
quested annually by the Tuberculosis Control 
Division, U. S. Public Health Service. 
Current File 
A file containing the latest known record for 
every tuberculosis case or suspect considered 
"administratively active” by the head of the 
State Tuberculosis Office. 
Closed File 
A file containing cases not administratively ac- 
tive—i.e., dead, lost, moved out of the State, or 
not in need of medical supervision as defined by 
State and local policies of case management. 
Follow-up 
A process of discovering, recording, and pe- 
riodically reviewing control activities to deter- 
mine present status of suspects and proven cases, 
as well as to indicate action needed. 
Initial Case Selection 
A process of choosing cases to be included at 
the time of the Central Record System installa- 
tion. 
Interchange of Information 
A method of maintaining current information 
on tuberculosis cases by circulation of informa- 
tion among the State health department, local 
health department and all other agencies or in- 
dividuals concerned with examination, diagnosis, 
treatment, or supervision of tuberculosis cases 
(such as private physicians, sanatoria, tubercu- 
losis associations, health department clinics and 
nurses, and public health nursing organiza- 
tions) . 
Information Interchange Form 
A general purpose form used between Central 
Record Systems and interested parties for the 
interchange of information to be used when a 
special purpose form is not indicated. 
Local Tuberculosis Case Register 
A system of records for maintaining a current 
summary of pertinent medical and public health 
data on those proven and suspected cases of 
tuberculosis which, according to health depart- 
ment policy, require some type of supervision 
. . . used primarily to direct the supervision of 
such cases. 
Master Index 
An alphabetical file which contains a card for 
every tuberculosis case ever reported and shows 
where record card is filed. 
Physician’s Periodic Report 
A method of follow up (questionnaire form, 
phone call or visit) to determine current status, 
82 preferably at 6-month intervals, of those tuber- 
culosis patients under care of a private phys- 
ician. 
Record Analyst 
The individual, qualified by education and ex- 
perience in records and statistics, who is re- 
sponsible for supervising the maintenance and 
use of the Central Record System and related 
records under the supervision of the tuberculosis 
control director. 
Semi-Annual Tuberculosis Report 
A summary report of mass radiography, tuber- 
culosis morbidity and mortality to be requested 
semi-annually by the Tuberculosis Control Di- 
vision, U. S. Public Health Service. 
State Central Record System 
A system of records for maintaining a current 
summary of pertinent medical and public health 
data on those proven and suspected cases of 
tuberculosis which, according to health depart- 
ment policy, require some type of supervision 
. . . essentially an administrative tool for pro- 
gram planning, supervision and evaluation. 
Status of Cases, Current 
Latest known supervision (in sanatorium or at 
home), activity of disease, or sputum status of 
patients. 
Vertical Visible or Offset Visible File 
A file with a series of overlapping, vertically- 
supported record cards allowing visibility of the 
right vertical margin. 
Worksheet 
An intermediate temporary record of each case 
used to simplify the mechanics of clearing and 
to aid in installing the record system. 
83 LOCAL CASE REGISTER 
Same card 
Space allowed for more details 
of contact history and home nur- 
sing visits. 
Pocket visible card optional 
—Sufficient to include 
all records for cases in county. 
Public Health Nurse and one 
clerk to maintain record system 
with case load up to 1,000. 
Primary use is to; 
Manage individual cases. 
CHART OF STATE CENTRAL CASE RECORD SYSTEM 
AND 
LOCAL CASE REGISTER 
Same 
Same 
Same 
* « S o 
?*s s*» 
•S s -o s 
•3 «s ~ 
<u 5 v 
a <n <0 c 
•d «J w 5 
<0 u 0 
C in 
c S t) . 
g - £ o 
n g'x) <0 
* 2 V o 
o 2 Z £ 
v 5 % c . 
v. C .X 00 C 
_ 3 w £ o 
O « g “ -S 
£ c 0 «j > 
« in +j g 
■H >1 -H c 4) 
U) U O 7 P- 
X 3 0) c 2 
n u a, c m 
Primary uses to: 
a. assist in establishing local case 
registers. 
b. define and describe the tuberculosis 
problem in the state. 
c. plan a tuberculosis control program. 
d. administer the program. 
c . . . , , 
f Sufficient to include 
all records for cases in state. 
Case records supervisor and clerks. 
(Number of clerks determined by size 
of problem.) 
a. clinics 
b. Public Health Nursing Divisions 
c. hospitals and sanatoria 
d. laboratories 
e. private physicans 
f. mass x-ray services 
g. Army and Navy 
h. Veterans’ Hospitals 
i. welfare agencies 
j. voluntary health agencies 
k. vital statistics bureaus 
l. other State and local health depart- 
ments 
STATE CENTRAL CASE 
RECORD SYSTEM 
CZ^, 
Vertical visible card 
3. CASE RECORD CARD 
7. FORMS FOR 
ROUTING INFORM - 
AT ION 
4. VISIBLE FILING 
EQUIPMENT 
6, SOURCES OF 
INFORMATION 
1. DEFINITION 
5. PERSONNEL 
2. USES P.H. NURSE 
PRIVATE 
PHYSICIAN 
MASS 
X-RAY 
LOCAL REGISTER 
Select according to policy which 
defines “administratively active" 
cases 
LABORATORY 
a. Same 
b. Same 
c. Route information to state 
health department. 
d. Signal for 
Individual case supervision. 
VITAL 
STATISTICS 
SANATORIUM 
CLINICS 
Same 
Same 
Cases reported within past five years. 
Select according to state policy which 
defines “administratively active" cases. 
STATE 
SANATORIUM 
Investigate readily available sources. 
a. Abstract information from reports. 
b. Enter material on record cards. 
c. Route information to proper health 
department. 
d. Signal for 
1. Maintenance of state program. 
2. Administration of program. 
VITAL 
STATISTICS 
I STATE 
LAB. 
STATE CENTRAL 
RECORD SYSTEM 
OUTSTATE 
REPORTS 
STATE 
CLINICS 
MASS 
X-RAY 
8. INITIAL CASES 
CLEARING FOR 
INITIAL CASES 
9. INTERCHANGE OF 
INFORMATION 
10. MAINTENANCE 
SELECTION OF 
INITIAL CASES 
85 INDEX 
Address, change of, 49, 67 
Administratively active, policy defined, 37, 59, 82 
Annual report, 77, 82, see figure 17, page 78 
Card, Local Register: arrangement in Current and 
Closed file, 59, 67; description of, 58; entries, 59; 
instruction for filling in, 59; signals, 65; see 
figure 15, page 61, and figure 15A, page 64. 
Card punch schedule, 77 
Card, State Central Case Record System: arrange- 
ment in Current file, in Closed file, in Master 
Index, 38, 49; description of, 18, 21; entries, 39; 
instructions for filling in, 39; signals, 45; see 
figure 4, page 19 and figure 4A, page 20. 
Case: policy regarding current and closed, 37; selec- 
tion of initial, 29, 82; status of, 37 
Case records, clearing of, 31 
Change of address, 49, 67 
Clearing: results of, 33; steps in, 31 
Clinic records, 4, 32, 35, 77 
Clinic reports, 25, 51, 68, see figure 7, page 25 
Closed file, 38, 59, 82 
Codes, punch card, 79 
Contacts, 63 
Cost: of installation, 14; maintenance, 14 
Current file, 38, 59, 82 
Daily Hospital Admission Summary, see figure 8, 
page 26 
Daily Hospital Discharge Summary, see figure 8A, 
page 26 
Death report, 27, 31, 34 
Disposition of cases, 30 
Entries: general directions, 39, 59; Local Register, 
59; State Central Case Record System, 39 
Equipment, 16, 58 
Files: Current, 38, 59, 82; Closed, 38, 59, 82; Mas- 
ter Index 38, 82, Vertical Visible, 16 
Follow-up, 5, 10, 45, 65, 82 
Forms: Annual Tuberculosis Report, see figure 17, 
page 78; Clinic Report, see figure 7, page 25; 
Daily Hospital Admission Summary, see figure 8, 
page 26; Daily Hospital Discharge Summary, see 
figure 8A, page 26; Hospital Discharge Report, 
see figure 9, page 26; Information Interchange, 
see figure 5, page 24; Local Register Card, see 
figure 15, page 61 and figure 15A, page 64; 
Master Index Card, see figures 12 and 12A, page 
38; Morbidity Report, see figure 6, page 25; Per- 
cent of Population served by local full time 
health officers and ratio of public health nurses 
to population, all States, 1942, see figure 1, page 
9; Query, see figure 10, page 27 and figure 11, 
page 33; Semi-Annual Tuberculosis Report, see 
figure 16, page 76; State Central Case Record 
System Card, see figure 4, page 19, figure 4A, 
page 20, figure 13, page 44 and figure 13A, page 
46; Statistical Tables, see pages 72 to 75. 
86 Glossary of terms, page 82 
Hospital Admission and Discharge Reports, 26, see 
figures 8, 8A and 9, page 26 
Information interchange, 23, 82, see figure 5, page 24 
Installation: of Local Register, 55; of State Central 
Record System, 36 
Interchange of information, 24, 82 
Interstate reciprocal reports, 28 
Kansas: clerical personnel, 37; Record System Card, 
20 
Laboratory reports, 27, 35 
Local health department records, 31, 34 
Local Register: definition, 82; installation, 55; main- 
tenance, 57; card, see figure 14, page 58, figure 
15, page 61 and figure 15A, page 64; chart, 
page 84 
Machine tabulation, 71 
Mass X-ray reports, 28 
Master Index, 38, 82; card, see figures 12 and 12A, 
page 38 
Morbidity reports, 25, see figure 6, page 25 
Nurses: ratio of public health to population, see fig- 
ure 1, page 9 
Nursing: information interchange, 24; public health 
nursing records, 26, 34, 52, 63, 68 
Oregon clerical personnel, 37 
Percent of population served by local full time health 
officers and ratio of public health nurses to popu- 
lation, all States, 1942, see figure 1, page 9 
Personnel: Clerical, 37, 56; Local Register, 57; State 
Central Case Record System, 36; Record Analyst, 
36; supervisory, 36 
Physicians, reports from private, 27, 32, 33, 35, 82, 
see figure 10, page 27 and figure 11, page 33 
Policy: definition of, 37; regarding current and 
closed cases, 37 
Population, percent of, served by local full time 
health officers, 9 
Public Health Nurse, see Nursing 
Punch Card: Code, 79; Schedule, 77 
Query form, see figure 10, page 27, and figure 11, 
page 33 
Record Analyst, 36, 83 
Record System, see State Central Case Record System 
Register, see Local Register 
Reports: Annual, 77, see figure 17, page 78; death 
27, 31; Interstate reciprocal 28; laboratory 27, 
local health department, 31; mass X-ray, 28; 
morbidity, 25, see figure 6, page 25; nursing, 26; 
sanatorium, 31; Selective Service, 28; Semi-an- 
nual, 77, 82; see figure 16, page 76; sputum, 53, 
69 
87 Routing information, 22, 50 
Sanatorium, see Forms and Reports 
Selective Service Reports, see Reports 
Semi-annual Tuberculosis Report. 77, 83, see figure 
16, page 76 
Signaling: general directions for, 45, 65; specific plan 
for, 47, 66, see figure 13, page 44 and figure 13A 
page 46 
Sputum reports, see reports 
State Central Case Record System: card for, 17, 39, 
see figure 4, page 19, figure 4A, page 20, figure 
13, page 44, figure 13A, page 46; equipment re- 
quired for, 16, see figures 2 and 3, page 17; his- 
tory of, 4; installation of, 13; maintenance of, 
36; need for, 7; policy for, 37; reports to, 25, 
51; selection of initial cases for, 29; signaling, 
45; statistical data secured from, 70; statistical 
tables, see pages 72 to 75; chart, pages 84 and 85 
Statistics, 70 
Vertical Visible file, 17, 83; see figures 2 and 3, page 
17; in use, see page 58 
Worksheet, 31, 8 
88 PAGE 
1. What is a State Central Record System for Tuberculosis? 4 
2, Why is a State Central Record System needed? 7 
3. How targe a task is the installation of a State Central 
Record System? 13 
4. What equipment is needed? 16 
TABU 
OF 
CONTENTS 
5. How can information he interchanged? 22 
6. How are initial cases selected? 21 
7. Haw is a State Central Record System installed and maintained? 30 
8. How is a local Register installed? 55 
0. How is a local Register maintained? S7 
10. What statistical data will the Central Record System provide? 70