
Get the free Tuberculosis Screening Form - Coconino County
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2625 N. King Street, Flagstaff AZ 86004 Phone: 928.679.7222 Fax: 928.679.7351STAFF USE Outpatient Name DOB / / Vaccine Lot NumberCholera Tap/IPA/Hep B Tap/IPA/His Tap/IPA Hep A Hep B Hep A/B His HPV9
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How to fill out tuberculosis screening form

How to fill out tuberculosis screening form
01
Start by obtaining the tuberculosis screening form from the appropriate medical facility or organization.
02
Read the instructions on the form carefully to understand the information that needs to be provided.
03
Fill in your personal details, including your full name, date of birth, and contact information.
04
Answer the screening questions honestly and accurately. These questions typically inquire about any previous history of tuberculosis, symptoms experienced, and contact with individuals diagnosed with tuberculosis.
05
Provide information about any previous tuberculosis tests or treatments that you have undergone.
06
If required, include any additional information or details as specified on the form.
07
Review the completed form to ensure all sections are filled out correctly and completely.
08
Submit the form to the designated authority or healthcare provider according to the given instructions.
09
Follow up with the healthcare provider or authority to receive the results of the tuberculosis screening.
Who needs tuberculosis screening form?
01
Anyone who requires tuberculosis screening for various reasons may need to fill out a tuberculosis screening form. This can include individuals who are symptomatic, individuals who have been in close contact with someone diagnosed with tuberculosis, healthcare workers, individuals participating in certain programs (such as immigration or employment requirements), and individuals traveling to certain countries with a higher tuberculosis prevalence.
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