Get the free Tuberculosis Screening Form - Mount St Marys University

****** For Office Use Only ****** COMPLIANT Last PPD CXR Results Tuberculosis Screening Form To be completed by student. This document is a screening tool used to determine potential exposure to active

How to fill out tuberculosis screening form

How to fill out a tuberculosis screening form:

1. Carefully read through the instructions provided on the form. These instructions will guide you on how to accurately fill out the form and provide the necessary information.
2. Begin by entering your personal information, such as your full name, date of birth, and contact details. Make sure to write legibly and provide accurate information.
3. Provide details about your medical history, including any past instances of tuberculosis or exposure to individuals with tuberculosis. If you have been previously treated for tuberculosis, indicate the treatment received and the duration of the treatment.
4. Answer the questions regarding your current health status. These questions typically inquire about symptoms you may be experiencing, any recent travel to countries with a high prevalence of tuberculosis, and any close contact with individuals diagnosed with tuberculosis.
5. If you have undergone any recent tuberculosis tests, indicate the date of the test and the results. This can include a tuberculin skin test (TST), chest x-ray, or other diagnostic tests related to tuberculosis.
6. Sign and date the form at the designated area, confirming that the information provided is accurate to the best of your knowledge.
7. Submit the completed tuberculosis screening form as instructed, whether that be to a healthcare provider, employer, or other relevant entity.

Who needs a tuberculosis screening form?

1. Individuals seeking employment in certain fields: Some industries, such as healthcare, education, or correctional facilities, require tuberculosis screening as a part of their employment process to ensure the safety of both employees and the public.
2. People intending to travel or live in countries with a high tuberculosis prevalence: Many countries, particularly those with a high incidence of tuberculosis, may require visitors or individuals planning to stay long-term to undergo tuberculosis screening.
3. Individuals at risk of contracting tuberculosis: People who have been in close contact with someone diagnosed with tuberculosis or those who have certain medical conditions that make them more susceptible to tuberculosis may need to undergo regular screening to monitor their health and detect any potential infection or reactivation of the disease.
4. Patients admitted to healthcare facilities or correctional institutions: To prevent the spread of tuberculosis within closed settings, such as hospitals or prisons, screening is often required for patients upon admission. This helps identify individuals with active tuberculosis or those who may be at an increased risk of developing the disease.
5. Anyone concerned about their tuberculosis status: If you are experiencing symptoms associated with tuberculosis or have reason to believe you may have been exposed to the infection, it's recommended to consult a healthcare professional who can assess your situation and determine if a tuberculosis screening is needed.

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What is tuberculosis screening form?

Tuberculosis screening form is a document used to assess individuals for the presence of tuberculosis infection.

Who is required to file tuberculosis screening form?

Individuals who are at risk of tuberculosis infection are required to file the tuberculosis screening form.

How to fill out tuberculosis screening form?

The tuberculosis screening form can be filled out by providing relevant personal information and history of exposure to tuberculosis.

What is the purpose of tuberculosis screening form?

The purpose of the tuberculosis screening form is to identify and monitor individuals who may have tuberculosis infection.

What information must be reported on tuberculosis screening form?

Information such as personal details, medical history, and exposure to tuberculosis must be reported on the tuberculosis screening form.