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Employee/Occupational Health Tuberculosis (TB) Screening First Name ___ Last Name___ Date of Birth: ___ Home Address: ___City: ___State:___ Zip:___ Last 4 SS#: ___ Cell phone #___Work # ___ Email:___
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The tb-questionnaire-formpdffillercomprintable tb questionnaire is a form used to gather information related to tuberculosis.
Individuals who are suspected of having tuberculosis or who have been exposed to tuberculosis may be required to fill out the form.
The form can be filled out online or printed and completed manually. It requires providing information about exposure to tuberculosis and any symptoms.
The purpose of the form is to assess the risk of tuberculosis infection and to provide necessary follow-up and treatment.
The form requires information about the individual's contact with tuberculosis patients, any symptoms of tuberculosis, and medical history related to tuberculosis.
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