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Health Services Dept. 200 W. Expressway 83 La Joy, Texas 78560 Tel (956) 3232615 Fax (956) 3232617 Grade/Teacher Tuberculosis Questionnaire Student Name: DOB: Date: Please read the following information
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How to fill out tuberculosis questionnaire
Who needs tuberculosis questionnaire?
01
People who have been in close contact with someone who has tuberculosis.
02
Individuals who have symptoms of tuberculosis, such as a persistent cough, weight loss, night sweats, or fatigue.
03
Healthcare workers and employees in high-risk settings, such as hospitals or nursing homes.
How to fill out tuberculosis questionnaire:
01
Start by reading the instructions provided with the questionnaire. Familiarize yourself with the purpose and importance of the questionnaire.
02
Gather all the necessary information before starting to fill out the form. This may include personal details like name, address, age, and contact information.
03
Begin by answering basic demographic questions, such as age, sex, occupation, and marital status.
04
Proceed to answer questions about any symptoms you may be experiencing. Be specific and provide accurate information about the duration, severity, and nature of the symptoms.
05
If you have been in contact with someone diagnosed with tuberculosis, provide details about the nature and duration of the contact. This may include living in the same household or spending a significant amount of time with the person.
06
Be prepared to provide information about any recent travel history, especially if you have visited countries with a high prevalence of tuberculosis.
07
Answer questions regarding your medical history, including any previous diagnosis of tuberculosis or treatment received.
08
Follow any additional instructions on the questionnaire, such as providing sputum samples for testing or undergoing a medical examination.
09
Review and double-check your answers before submitting the questionnaire. Ensure that all information is accurate and complete.
10
If you have any doubts or concerns while filling out the tuberculosis questionnaire, consult with a healthcare professional for guidance and clarification.
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What is tuberculosis questionnaire?
The tuberculosis questionnaire is a form used to collect information about a person's exposure to tuberculosis, symptoms, and other relevant details.
Who is required to file tuberculosis questionnaire?
Healthcare providers, laboratories, and other healthcare facilities are required to file tuberculosis questionnaires.
How to fill out tuberculosis questionnaire?
The tuberculosis questionnaire can be filled out by providing accurate and complete information about the individual's history of tuberculosis exposure, symptoms, and any relevant medical history.
What is the purpose of tuberculosis questionnaire?
The purpose of the tuberculosis questionnaire is to help healthcare providers assess the risk of tuberculosis infection in individuals and provide appropriate treatment and preventive measures.
What information must be reported on tuberculosis questionnaire?
Information such as the individual's history of tuberculosis exposure, symptoms, any previous treatment, and other relevant medical history must be reported on the tuberculosis questionnaire.
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