Please use this online submission form to request LTBI medication through the MDH's TB Medications Program. You may experience some issues using Internet Explorer. To complete your request, you will need to answer all required fields. This includes:

  • patient demographic information,
  • medical history,
  • LTBI screening information,
  • an electronic copy of the prescription for LTBI medication, and
  • an electronic copy of the patient's insurance information.

Should you be unable to complete in one sitting, you will be provided a code to resume your request within 31 days. A request will only be submitted to MDH after it is complete. After the request is submitted, you will not be able to access it. You may contact the TB Medications Program by calling 651-201-5414 or toll-free 1-877-676-5414 with any questions or changes to submitted requests. See the program website for more information. This link will open a new browser tab: https://www.health.state.mn.us/diseases/tb/meds/index.html

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