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Name of Person in Care: TUBERCULOSIS RISK ASSESSMENT FORM FOR PERSONS IN CARE OF COMMUNITY CARE FACILITIES 60 YEARS AND OLDER Residents 60 years and older will be assessed for symptoms of active TB
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How to fill out tuberculosis risk assessment form
How to fill out tuberculosis risk assessment form
01
Read the instructions on the form carefully to understand the requirements.
02
Provide your personal information such as name, date of birth, and contact details.
03
Answer all the questions accurately and honestly based on your medical history.
04
If you have been diagnosed with tuberculosis before, provide details of the diagnosis and treatment.
05
Indicate any known risk factors for tuberculosis such as close contact with someone infected or travel to high-risk areas.
06
If you have any symptoms related to tuberculosis, describe them in detail.
07
If you have had a tuberculosis test, include the results and the date of the test.
08
Sign and date the form to certify the accuracy of the information provided.
Who needs tuberculosis risk assessment form?
01
Individuals who are suspected of having tuberculosis or are at high risk of contracting the disease.
02
Healthcare professionals who need to assess the tuberculosis risk for their patients.
03
Employers who want to evaluate the risk of tuberculosis among their employees in certain industries.
04
Travelers planning to visit countries with a high incidence of tuberculosis.
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What is tuberculosis risk assessment form?
The tuberculosis risk assessment form is a document used to assess the risk of individuals contracting tuberculosis.
Who is required to file tuberculosis risk assessment form?
Healthcare facilities and employers are typically required to file tuberculosis risk assessment forms for their employees.
How to fill out tuberculosis risk assessment form?
The form can be filled out by providing information about the individual's medical history, exposure to tuberculosis, and any symptoms they may be experiencing.
What is the purpose of tuberculosis risk assessment form?
The purpose of the form is to identify individuals who may be at risk of contracting tuberculosis and to provide appropriate medical care and preventive measures.
What information must be reported on tuberculosis risk assessment form?
Information such as medical history, exposure to tuberculosis, and symptoms must be reported on the form.
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