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TEMPLATE: Customize as needed 02/2021 Tuberculosis Contact Evaluation Form Initial contact date: Tennessee WarningInterpreter needed: No Yes: Demographic Information Name: Sex: DOB: 5 y/o Street/City/ZIP:
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How to fill out tb contact evaluation template

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How to fill out tb contact evaluation form

01
To fill out the TB contact evaluation form, follow these steps:
02
Start by entering the personal information of the person being evaluated, such as their name, age, and sex.
03
Provide details about the person's contact with a confirmed TB patient, including the duration and frequency of contact.
04
Specify any symptoms or signs of TB that the person may be experiencing.
05
Indicate the results of any medical tests performed on the person, such as TB skin tests or chest X-rays.
06
Mention any existing medical conditions or medications currently being taken by the person.
07
Provide information about any TB treatment the person has received in the past.
08
Include additional notes or comments relevant to the evaluation of TB contact.
09
Review the form for accuracy and completeness before submission.

Who needs tb contact evaluation form?

01
The TB contact evaluation form is needed by healthcare professionals or authorized personnel responsible for assessing individuals who have had contact with someone diagnosed with tuberculosis (TB). This includes doctors, nurses, public health officials, and researchers.

What is TB Contact Evaluation Template Form?

The TB Contact Evaluation Template is a writable document needed to be submitted to the required address to provide specific info. It must be filled-out and signed, which may be done manually in hard copy, or with the help of a certain solution e. g. PDFfiller. This tool lets you complete any PDF or Word document directly in your browser, customize it according to your requirements and put a legally-binding e-signature. Right away after completion, user can easily send the TB Contact Evaluation Template to the relevant person, or multiple individuals via email or fax. The editable template is printable as well thanks to PDFfiller feature and options presented for printing out adjustment. Both in electronic and physical appearance, your form should have a organized and professional look. It's also possible to turn it into a template for later, so you don't need to create a new document from the beginning. You need just to customize the ready document.

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The TB contact evaluation form is a document used to assess and document the health status of individuals who have been in close contact with a person diagnosed with tuberculosis (TB).
Health care providers and public health officials are required to file the TB contact evaluation form for individuals identified as close contacts of a confirmed TB case.
To fill out the TB contact evaluation form, one should provide personal information of the contact, details of their exposure, any symptoms they may be experiencing, and results from any previous TB tests.
The purpose of the TB contact evaluation form is to gather crucial information that aids in the identification, diagnosis, and management of TB cases among those who may have been exposed to the disease.
The form must report information such as the individual's name, contact details, relationship to the TB case, medical history, TB test results, and any symptoms experienced.
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