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Get the free Children TB Risk Assessment Form - Mass.gov

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PEDIATRIC TB RISK ASSESSMENT FORM Physician/ Health Provider:Phone:Date:Child's Name: Date of Birth: / / Address: City: State: County: Sex: Male Female Hispanic: No Terrace: White Black Asian Am.
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Children TB risk assessment is a screening tool used to assess the risk of tuberculosis in children.
Healthcare providers and institutions working with children are required to file children TB risk assessment.
Children TB risk assessment can be filled out by providing relevant medical and demographic information about the child.
The purpose of children TB risk assessment is to identify children who may be at risk for tuberculosis and provide appropriate interventions.
Information such as symptoms, exposure to TB, medical history, and family history must be reported on children TB risk assessment.
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