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MANDATORY TUBERCULOSIS SCREENING FORM FOR THIRD YEAR (M3) FAR MEDICAL STUDENTS 2014-2015 Return completed forms by April 21, 2014, to: FAR Immunization Office, SU-80, Room 114, 777 Glades Road, Boca

How to fill out mandatory tuberculosis screening form

How to fill out a mandatory tuberculosis screening form:

1. Begin by filling out your personal information, including your full name, date of birth, and contact information.
2. Provide your medical history, including any previous history of tuberculosis or exposure to tuberculosis.
3. Indicate if you have any symptoms related to tuberculosis, such as coughing, fever, or night sweats.
4. Answer questions about your recent travel history, especially if you have visited countries with a high prevalence of tuberculosis.
5. Provide details about your current living situation, such as whether you reside in a congregate setting or have close contact with individuals at higher risk for tuberculosis.
6. If applicable, provide information about your employment, particularly if you work in a healthcare setting or other high-risk environment.
7. Sign and date the form to indicate that the information you have provided is accurate to the best of your knowledge.

Who needs a mandatory tuberculosis screening form:

1. Individuals who are required by law or regulation to undergo regular tuberculosis screenings, such as healthcare workers, educators, and individuals in congregate settings like prisons or nursing homes.
2. Individuals who have been exposed to someone with active tuberculosis.
3. Individuals who have symptoms suggesting possible tuberculosis infection, such as persistent cough, unexplained weight loss, or prolonged fever.
4. Individuals planning to immigrate or travel to countries with a high prevalence of tuberculosis.
5. Individuals seeking employment in specific fields that require tuberculosis screening as a condition of employment, such as healthcare or childcare.
6. Individuals who have been referred for tuberculosis screening by their healthcare provider based on specific risk factors or concerns.

For pdfFiller’s FAQs

What is mandatory tuberculosis screening form?

Mandatory tuberculosis screening form is a document that individuals must complete to identify and assess their risk of tuberculosis infection.

Who is required to file mandatory tuberculosis screening form?

Individuals who are at risk of tuberculosis infection, such as healthcare workers or individuals in close contact with TB patients, are required to file the mandatory tuberculosis screening form.

How to fill out mandatory tuberculosis screening form?

The mandatory tuberculosis screening form can be filled out by providing personal information, medical history, and completing the required screening questions.

What is the purpose of mandatory tuberculosis screening form?

The purpose of the mandatory tuberculosis screening form is to assess an individual's risk of tuberculosis infection and to take necessary precautions to prevent the spread of the disease.

What information must be reported on mandatory tuberculosis screening form?

The mandatory tuberculosis screening form requires information such as personal details, medical history, recent exposure to TB patients, and any symptoms of tuberculosis.

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