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TUBERCULOSIS SYMPTOM AND RISK ASSESSMENT QUESTIONNAIRE PLEASE PRINT LEGIBLY Name: Date of Birth: Status:Department / School: FacultyStaffEmployer (circle all that apply):Student IU Health, Health

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How to fill out tuberculosis symptom and risk

01

To fill out the tuberculosis symptom and risk form, follow these steps:

02

Begin by providing your personal information, including your full name, date of birth, and contact details.

03

Answer the questions about your medical history. Include any previous or current medical conditions, surgeries, or treatments you have received.

04

Specify any symptoms related to tuberculosis that you may be experiencing. These may include coughing, chest pain, fatigue, weight loss, night sweats, and blood in sputum.

05

Indicate if you have any risk factors for tuberculosis. These risk factors may include close contact with someone who has active tuberculosis, living or working in crowded places like prisons or homeless shelters, weakened immune system due to HIV/AIDS or other conditions, and recent travel to countries with a high prevalence of tuberculosis.

06

If you have recently been in contact with someone diagnosed with tuberculosis, provide detailed information about the duration and nature of the contact.

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Finally, review your form to ensure all information is accurate and complete before submitting it.

Who needs tuberculosis symptom and risk?

01

Anyone who suspects they may have symptoms or risk factors related to tuberculosis should fill out the tuberculosis symptom and risk form.

02

This form is especially important for individuals who have been in close contact with someone diagnosed with tuberculosis, have recently traveled to countries with a high prevalence of tuberculosis, or have a weakened immune system.

03

It is also important for healthcare professionals to utilize this form when assessing patients for tuberculosis symptoms and risk factors.

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What is tuberculosis symptom and risk?

Tuberculosis symptoms include coughing, chest pain, fever, weight loss, and night sweats. Risk factors include close contact with an infected person, weakened immune system, and living in crowded conditions.

Who is required to file tuberculosis symptom and risk?

Healthcare providers and facilities are required to report tuberculosis symptoms and risks to the appropriate health authorities.

How to fill out tuberculosis symptom and risk?

To fill out the tuberculosis symptom and risk form, healthcare providers need to document the patient's symptoms, medical history, and potential exposure to tuberculosis.

What is the purpose of tuberculosis symptom and risk?

The purpose of reporting tuberculosis symptoms and risks is to track and monitor cases, prevent outbreaks, and provide timely treatment.

What information must be reported on tuberculosis symptom and risk?

Information to be reported includes patient's symptoms, medical history, potential exposure to tuberculosis, and any relevant test results.

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