OH Consent for Tuberculin Skin Test - City of Massillon 2010 free printable template

CONSENT FOR TUBERCULIN SKIN TEST LAST NAME FIRST NAME MI ADDRESS DATE OF BIRTH CITY STATE ZIP CODE PHONE 1. Have you ever had a TB Skin Test? Yes No 2. Have you ever had a positive reaction to a TB

How to fill out OH Consent for Tuberculin Skin Test

How to fill out OH Consent for Tuberculin Skin Test - City

1. Obtain the OH Consent form for the Tuberculin Skin Test from the designated health office or website.
2. Read the instructions and information provided on the form carefully.
3. Fill in your personal information, including your name, date of birth, and contact details.
4. Indicate the purpose of the Tuberculin Skin Test in the designated section of the form.
5. Provide any relevant medical history, including past TB tests and vaccinations.
6. Sign and date the form to indicate your consent for the test.
7. Submit the completed form to the appropriate health care provider or organization.

Who needs OH Consent for Tuberculin Skin Test - City?

1. Individuals who are required to undergo a Tuberculin Skin Test for employment or school entry.
2. People who are at high risk for tuberculosis exposure due to occupation or living conditions.
3. Anyone who has symptoms suggestive of tuberculosis and needs to confirm their TB status.
4. Patients who are being evaluated for TB exposure or infection based on public health guidelines.

People Also Ask about

How is TB test done for immigration?

You'll be given a chest x-ray to test for TB . If the result of the x-ray is not clear you may also be asked to give a sputum sample (phlegm coughed up from your lungs). If your test shows that you do not have TB , you'll be given a certificate which is valid for 6 months from the date of your x-ray.

What are the 4 TB screening questions?

Please answer the following questions: Have you ever had a positive TB skin test? Have you ever had close contact with anyone who was sick with TB? Have you ever been vaccinated with BCG? * The significance of the travel exposure should be discussed with a health care provider and evaluated.

How do you document TB skin test?

TST Documentation Requirements Name and signature of person administering test. Date and time test administered. Location of test (e.g., right forearm, left forearm, alternate site) Tuberculin manufacturer, lot number and expiration date.

What are the steps of TB screening?

A TB skin test requires two visits with a health care provider. On the first visit the test is placed; on the second visit the health care provider reads the test. The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm.

Who recommended 4 symptom screen for TB?

Background: Since 2011, WHO recommends a four-symptom screening rule to exclude active tuberculosis in people living with HIV before starting tuberculosis preventive treatment (ie, absence of current cough, weight loss, night sweats, or fever).

What sample required for TB test?

The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.

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What is OH Consent for Tuberculin Skin Test - City?

OH Consent for Tuberculin Skin Test - City is a form that allows individuals to consent to undergo a tuberculosis (TB) screening test using a skin test method, typically performed by healthcare professionals.

Who is required to file OH Consent for Tuberculin Skin Test - City?

Individuals who are required to undergo a Tuberculin Skin Test, such as healthcare workers, students in healthcare programs, and individuals in certain employment settings where TB screening is mandated, must file the OH Consent.

How to fill out OH Consent for Tuberculin Skin Test - City?

To fill out the OH Consent, individuals should provide personal information such as their name, date of birth, and contact information, as well as read and sign the consent statement to acknowledge understanding of the test and its purpose.

What is the purpose of OH Consent for Tuberculin Skin Test - City?

The purpose of the OH Consent for Tuberculin Skin Test - City is to ensure that individuals are informed about the testing process, understand the implications of the test, and voluntarily consent to participate in tuberculosis testing.

What information must be reported on OH Consent for Tuberculin Skin Test - City?

Required information on the OH Consent includes the individual's full name, date of birth, contact information, date of the test, and a declaration of consent that acknowledges understanding of the test and its potential results.