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Applicant Name (Last, First, Middle Initial)Date of Birth / / Medical Case Number: Reactive Tuberculin Form OMB No.: 04200550 Expiration Date: 1/31/2014(Mo/Day/Year)REACTIVE TUBERCULIN TEST EVALUATION
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How to fill out reactive tuberculin form
How to fill out reactive tuberculin form
01
Begin by gathering all necessary information and materials, including the reactive tuberculin form, a pen or pencil, and any relevant medical records.
02
On the form, fill out your personal information including your full name, date of birth, and contact information.
03
Provide your medical history, including any previous diagnoses of tuberculosis or exposure to the disease.
04
Indicate the date and location of your tuberculin test.
05
Record the results of the test, including the size of the induration (swelling) at the injection site.
06
Sign and date the form to certify its accuracy.
07
Submit the completed form to the appropriate healthcare professional or institution as instructed.
Who needs reactive tuberculin form?
01
The reactive tuberculin form is usually required for individuals who have undergone tuberculin testing, such as a Mantoux test or TST (Tuberculin Skin Test), and have received a positive result. This form is typically used for documentation and reporting purposes, allowing healthcare providers or institutions to track and monitor individuals who may be at risk for tuberculosis.
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What is reactive tuberculin form?
Reactive tuberculin form is a form used to report positive results for tuberculin skin tests.
Who is required to file reactive tuberculin form?
Healthcare providers are required to file reactive tuberculin form.
How to fill out reactive tuberculin form?
Reactive tuberculin form should be filled out with patient information, test date, test result, and provider details.
What is the purpose of reactive tuberculin form?
The purpose of reactive tuberculin form is to document positive tuberculin skin test results.
What information must be reported on reactive tuberculin form?
Patient information, test date, test result, and provider details must be reported on reactive tuberculin form.
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