Get the free Tuberculosis Screening Form - Hampshire College

HAMPSHIRE COLLEGE HEALTH & COUNSELING SERVICES PH (413) 559. 559.5458893 West Street, Amherst, MA 01002 FX (413) 559.5583 health services Hampshire. Tuberculosis SCREENING THIS FORM IS REQUIRED STUDENT

How to fill out tuberculosis screening form

How to fill out tuberculosis screening form

1. Obtain a copy of the tuberculosis screening form from the relevant healthcare facility or employer.
2. Read the instructions and familiarize yourself with the purpose and requirements of the screening form.
3. Start by providing your personal information, such as your full name, date of birth, and contact details.
4. Proceed to answer the screening questions regarding your medical history, including any previous diagnosis or treatment of tuberculosis.
5. Answer additional questions about your symptoms, if any, such as persistent cough, night sweats, or unexplained weight loss.
6. If applicable, provide information about any recent travels to regions or countries with a high incidence of tuberculosis.
7. Indicate whether you have been in close contact with anyone diagnosed with tuberculosis.
8. Leave no sections blank unless instructed otherwise, and if a particular question doesn't apply to you, mark it accordingly.
9. Review your answers and make sure all information provided is accurate and legible.
10. Sign and date the form as required, verifying that the information you provided is true and correct.
11. Submit the completed form to the designated healthcare provider or employer as instructed.

Who needs tuberculosis screening form?

1. Anyone who falls under the following categories may need to fill out a tuberculosis screening form:
2. - Individuals applying for certain jobs or volunteer positions that require close contact with vulnerable populations, such as healthcare workers, teachers, and daycare staff.
3. - People who are planning to study or work abroad in countries with a higher prevalence of tuberculosis.
4. - Individuals who have been in close contact with someone diagnosed with tuberculosis.
5. - Those seeking admission to certain educational institutions or residential facilities.
6. - Individuals with persistent respiratory symptoms or other signs that may indicate possible tuberculosis infection.
7. - People with compromised immune systems, such as those living with HIV/AIDS or receiving immunosuppressive therapies.
8. It is advisable to consult with the specific healthcare provider or employer to determine if you need to fill out a tuberculosis screening form.

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What is tuberculosis screening form?

Tuberculosis screening form is a document used to assess an individual's risk of having tuberculosis.

Who is required to file tuberculosis screening form?

Individuals working in healthcare facilities, correctional facilities, and homeless shelters are required to file tuberculosis screening form.

How to fill out tuberculosis screening form?

To fill out tuberculosis screening form, one must provide personal information, medical history, and complete a questionnaire about potential tuberculosis exposure.

What is the purpose of tuberculosis screening form?

The purpose of tuberculosis screening form is to identify individuals who may have tuberculosis and to prevent the spread of the disease.

What information must be reported on tuberculosis screening form?

Information such as personal details, medical history, recent travel history, and contact with individuals with tuberculosis must be reported on tuberculosis screening form.