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Student Name (please print) ___Date of Birth___LastFirstFormClark House 202324 TUBERCULOSIS MEDICAL EVALUATION TO BE COMPLETED BY HEALTH CARE PROVIDER (FAMILY MEMBER)TO PROVIDER: Please complete the
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Familiarize yourself with the specific standards of care for the particular industry or profession.
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Who needs standards of care for?

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Professionals in healthcare, legal, construction, finance, and various other industries are required to adhere to standards of care.
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Standards of care are guidelines and protocols that healthcare professionals must follow to ensure quality patient care.
Healthcare facilities and providers are required to file standards of care.
Standards of care can be filled out by documenting procedures, protocols, and guidelines followed in patient care.
The purpose of standards of care is to ensure consistent and high-quality patient care.
Information such as patient outcomes, adherence to protocols, and any incidents or deviations from standards must be reported.
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