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DEPARTMENT OF HEALTH SERVICES Division of Public Health F02314E (02/2020)STATE OF WISCONSIN Page 1 of 2WISCONSIN TUBERCULOSIS (TB) RISK ASSESSMENT AND SYMPTOM EVALUATION FOR ANNUAL EMPLOYEE SCREENING

How to fill out wisconsin tuberculosis tb risk

How to fill out wisconsin tuberculosis tb risk

1. To fill out Wisconsin tuberculosis (TB) risk, follow these steps:
2. Begin by providing your personal information, including your name, date of birth, and contact information.
3. Indicate your current occupation and whether you work in a healthcare setting.
4. Answer the questions regarding your TB exposure history, such as whether you have had close contact with someone who has active TB.
5. Provide information about any previous TB testing you have undergone, including the dates and results.
6. Fill out the section on your medical history, including any previous diagnosis or treatment of TB, and any relevant symptoms.
7. Answer the questions relating to your travel history, particularly if you have recently visited areas with a high prevalence of TB.
8. Complete the risk assessment section, indicating your risk level based on the provided criteria.
9. Sign and date the form before submitting it for further evaluation and review.
10. For more detailed instructions or questions, refer to the official documentation or consult with a healthcare professional.

Who needs wisconsin tuberculosis tb risk?

1. Wisconsin tuberculosis (TB) risk form is needed by individuals who:
2. - Live or work in an environment where they may be exposed to TB, such as healthcare workers
3. - Have a history of close contact with someone who has active TB
4. - Have traveled to areas with a high prevalence of TB
5. - Have symptoms suggestive of TB, such as persistent cough, night sweats, and weight loss
6. - Have previously been diagnosed or treated for TB
7. - Are required by their employer, educational institution, or healthcare provider to undergo TB risk assessment
8. It is important to consult with a healthcare professional to determine if you need to fill out and submit the Wisconsin TB risk form.

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What is Wisconsin tuberculosis TB risk?

Wisconsin tuberculosis TB risk refers to the assessment of potential exposure to and the likelihood of contracting tuberculosis within the state of Wisconsin. This includes evaluating factors such as local incidence rates, demographics, and specific risk factors for individuals.

Who is required to file Wisconsin tuberculosis TB risk?

Healthcare professionals, laboratories, and healthcare facilities that diagnose or suspect cases of tuberculosis are required to file Wisconsin tuberculosis TB risk reports. Additionally, individuals in certain high-risk settings may also need to submit reports.

How to fill out Wisconsin tuberculosis TB risk?

To fill out Wisconsin tuberculosis TB risk, individuals must gather relevant patient information, including medical history, exposure history, and results of TB tests. The information must then be entered into the designated reporting form provided by the Wisconsin Department of Health Services.

What is the purpose of Wisconsin tuberculosis TB risk?

The purpose of Wisconsin tuberculosis TB risk is to monitor and control the spread of tuberculosis in the state. This reporting helps in assessment, treatment, and prevention strategies to protect public health.

What information must be reported on Wisconsin tuberculosis TB risk?

Reported information must include patient demographics, TB test results, clinical findings, history of TB exposure, and any treatment administered or recommended.