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Virginia Department of Health Division of Disease Prevention TB Control TB Risk Assessment (TB 512) Patient name (L, F, M): Address: Home Telephone #:Work Telephone #:DOB:Sex:Cell Phone #:Social Security

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Electronic health record is a digital version of a patient's paper chart that includes information about the patient's medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory test results.

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Healthcare providers, hospitals, and other healthcare organizations are required to file using electronic health record.

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Information that must be reported on using electronic health record includes patient demographics, medical history, diagnoses, medications, treatment plans, immunizations, allergies, radiology images, and laboratory test results.

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