A review of a hospital patient management system revealed that 12 other patients were seen in the emergency departments while on active alert lists. Some patients were seen more than once while on the list. Some cases showed that the chest x-rays were performed as requested but the patient records did not indicate if the procedure was prompted due to the alert or because the patient presented with symptoms of TB. A review of the process is underway to better understand why these encounters did not provide a notification to the MCPHD.