Get the free Initial PPD Screening Form - School of Social Work - socialwork uw

Tuberculosis Screening Form B for: Nursing, FedEx, Social Work, and exec MPH Students Entering: 20152016, University of Washington Part I. STUDENT INFORMATION (please type or print legibly) This section

How to fill out initial ppd screening form

How to fill out initial PPD screening form?

1. Obtain the form: The initial PPD screening form can usually be obtained from your healthcare provider or the organization conducting the screening.
2. Personal information: Start by providing the necessary personal information such as your full name, date of birth, address, and contact information. This ensures accurate identification and communication.
3. Medical history: Provide details about your medical history, including any relevant past illnesses, surgeries, or previous exposure to tuberculosis (TB). Answer all the questions truthfully and to the best of your knowledge.
4. TB symptoms: Indicate whether you have experienced any symptoms associated with TB, such as prolonged coughing, chest pain, fatigue, weight loss, or night sweats. If you have any of these symptoms, it is important to mention them as they may require further investigation.
5. TB exposure risk factors: Mention any potential risk factors for TB exposure, such as close contact with someone diagnosed with TB, living or working in a high-risk environment (e.g., healthcare facilities or correctional facilities), or traveling to a country with a high prevalence of TB.
6. Mantoux tuberculin skin test (TST): If you have undergone a TST in the past, record the date, result, and any associated symptoms or complications. This helps in assessing your TB status and monitoring any adverse reactions.
7. BCG vaccination: Specify whether you have received the Bacillus Calmette-Guérin (BCG) vaccine, commonly used in some countries to prevent TB. Include the date of vaccination if known.
8. Signature and date: Read the form thoroughly and sign it once you have completed all the necessary sections. Don't forget to add the date as well.

Who needs initial PPD screening form?

1. Individuals in high-risk occupations: Healthcare workers, laboratory personnel, and those working in correctional facilities or homeless shelters often need to undergo initial PPD screening due to their increased exposure to TB.
2. Close contacts: People who have had prolonged and close contact with individuals diagnosed with TB are at higher risk and may be required to fill out an initial PPD screening form.
3. Travelers: Individuals traveling to countries with a high prevalence of TB may be asked to complete the initial PPD screening form before departure or upon their return, depending on the guidelines of the destination country.
4. Immigrants and refugees: Some countries have specific regulations requiring immigrants and refugees to undergo initial PPD screening as part of their immigration or asylum process.
5. Students: Certain educational institutions, particularly those in the healthcare field, may request students to complete the initial PPD screening form as a requirement before starting clinical placements or internships.

Note: The specific requirements for who needs to fill out the initial PPD screening form may vary based on local health department guidelines, institutional policies, and job requirements. It is always best to consult with your healthcare provider or the relevant authorities to determine if you need to fill out the form.

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What is initial ppd screening form?

The initial ppd screening form is a document used to screen individuals for tuberculosis (TB) infection.

Who is required to file initial ppd screening form?

Employers are required to file the initial ppd screening form for their employees.

How to fill out initial ppd screening form?

The initial ppd screening form can be filled out by providing personal information, medical history, and undergoing the necessary tests for TB screening.

What is the purpose of initial ppd screening form?

The purpose of the initial ppd screening form is to identify individuals who may have TB infection and prevent its spread in the workplace.

What information must be reported on initial ppd screening form?

The initial ppd screening form must include personal details, medical history, TB test results, and any necessary follow-up actions.