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TUBERCULOSIS SCREENING QUESTIONNAIREPatient Name: Date of Birth: Person completing the questionnaire: Date: Please answer the following questions, or review your previous answers and let us know if
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How to fill out person completing form questionnaire

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Start by reading the instructions provided with the form questionnaire.
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Begin by filling out the personal information section such as name, address, date of birth, etc.
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Read each question carefully and provide accurate and honest responses.
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If there are multiple choice questions, select the most appropriate option.
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Person completing the questionnaire: Date: template instructions

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The person completing the form questionnaire is an individual providing information as requested in the form.
The person required to file the form questionnaire is typically the individual named on the form or someone completing it on behalf of the named individual.
The form questionnaire should be filled out completely and accurately, following the instructions provided on the form.
The purpose of the form questionnaire is to gather specific information from the individual named on the form.
The information required to be reported on the form questionnaire will depend on the specific questions asked on the form.
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