Get the free tb screening questionnaire - County of San Diego

TB SCREENING QUESTIONNAIRE CLIENT:DOB: Lasted No.:First ARE YOU COUGHING FOR MORE THAN 3 WEEKS? Have you recently coughed up blood?YES YES NO Mohave you lost more than 5 lbs in the last 2 months?YESNOHad

How to fill out tb screening questionnaire

How to fill out a TB screening questionnaire:

1. Read the instructions carefully: Start by thoroughly reading the instructions provided with the TB screening questionnaire. This will help you understand the purpose of the questionnaire and how to accurately complete it.
2. Provide personal information: The TB screening questionnaire will typically require you to provide personal information such as your full name, date of birth, contact details, and any other relevant information requested.
3. Answer demographic questions: The questionnaire may include demographic questions, such as your gender, ethnicity, occupation, and residential address. Ensure that you provide accurate information to help in assessing your TB risk accurately.
4. Answer medical history questions: The questionnaire may have a section dedicated to your medical history. You will be asked about any previous instances of tuberculosis, previous testing for TB, or any related health conditions you may have had.
5. Complete symptom assessment: Most TB screening questionnaires include a section where you are required to report any symptoms you may be experiencing. These symptoms may include coughing, chest pain, unexplained weight loss, fatigue, night sweats, or others that may be indicative of TB infection.
6. Provide recent travel history: If you have traveled recently, especially to areas with a high incidence of TB, the questionnaire will likely ask you to provide details about your travel history. Be sure to include all relevant locations and dates of travel.
7. Review and double-check: Once you have filled out the TB screening questionnaire, take a few moments to review all the answers you have provided. Double-check for any errors or omissions, as accuracy is crucial for an effective screening process.

Who needs a TB screening questionnaire:

1. Individuals with possible exposure to TB: Anyone who may have had close contact with a person infected with TB or has been in an environment with a high risk of TB transmission should complete a TB screening questionnaire. This includes healthcare workers, close contacts of TB patients, and individuals living or working in crowded or high-risk settings.
2. Individuals seeking employment or education in certain fields: Some professions or educational programs (such as healthcare workers, teachers, or students in healthcare-related courses) may require individuals to undergo TB screening. In such cases, a TB screening questionnaire is often used to assess the individual's risk and determine the need for further testing.
3. Individuals with symptoms or risk factors: Anyone experiencing symptoms or risk factors associated with TB should consider completing a TB screening questionnaire. Symptoms may include persistent cough, unexplained weight loss, and night sweats, while risk factors may include recent travel to high TB burden areas or close contact with TB patients.

Remember, the purpose of the TB screening questionnaire is to identify individuals who may require further testing or evaluation for tuberculosis. If the questionnaire highlights any potential risks or symptoms, it is important to follow up with a healthcare professional for proper diagnosis and management.

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What is tb screening questionnaire?

The TB screening questionnaire is a form used to assess an individual's risk of having tuberculosis (TB) infection.

Who is required to file tb screening questionnaire?

Individuals who are at risk of TB infection or have been exposed to TB are required to fill out the screening questionnaire.

How to fill out tb screening questionnaire?

The TB screening questionnaire can be filled out by answering the questions provided on the form regarding symptoms, travel history, and exposure to TB.

What is the purpose of tb screening questionnaire?

The purpose of the TB screening questionnaire is to identify individuals who may be at risk of having TB infection in order to provide early detection and treatment.

What information must be reported on tb screening questionnaire?

Information such as symptoms, travel history, and exposure to TB must be reported on the TB screening questionnaire.