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New Patient Questionnaire Name: ___ Date:___ I was referred by: ___ My doctors include: ___ ___ I have had chest imaging (chest rays or CT chest) from: Radiology Imaging Associates (RIA) Cleveland
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Start by carefully reading the questions on the post-chest x-ray TB questionnaire.
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Answer each question truthfully and accurately.
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Provide the necessary information such as your personal details, medical history, and any relevant symptoms or conditions.
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Who needs post-chest x-ray tb questionnaire?

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Individuals who have undergone a chest x-ray to screen for tuberculosis (TB) may be required to fill out a post-chest x-ray TB questionnaire.
02
People who exhibited abnormal or suspicious findings in their chest x-ray results may be asked to complete this questionnaire.
03
Healthcare providers and medical professionals who are involved in the diagnosis and treatment of TB patients may use this questionnaire to gather additional information about the individual's health and symptoms.
04
Government agencies or research institutions conducting TB surveillance or studies may also request individuals to complete the post-chest x-ray TB questionnaire.
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The post-chest x-ray TB questionnaire is a form used to collect information about individuals who have undergone a chest x-ray to check for tuberculosis (TB) after potential exposure or symptoms suggesting TB.
Individuals who have undergone a chest x-ray as part of TB screening, especially those exposed to TB or exhibiting symptoms, are required to file the post-chest x-ray TB questionnaire.
To fill out the post-chest x-ray TB questionnaire, individuals should provide their personal details, the date of the chest x-ray, the results, any symptoms experienced, and any additional relevant medical history.
The purpose of the post-chest x-ray TB questionnaire is to assess the presence of tuberculosis, track potential cases, and ensure proper follow-up and treatment for those exposed or affected.
The questionnaire must report personal identification details, date of the chest x-ray, outcome or results of the x-ray, any symptoms of TB, and any relevant medical history or past TB treatment.
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