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Tuberculin (TB) Symptom Screening Form
(for Admission to the major or annual screening)
Department of NursingName ___
Date of return to the U.S. ___Today Date___Date of last negative chest ray ___Symptoms
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How to fill out tuberculin symptom screening form
How to fill out tuberculin symptom screening form
01
Start by filling out personal information such as name, date of birth, and contact information.
02
Indicate if you have had a previous positive tuberculosis (TB) test result.
03
Check off any symptoms of TB that you are currently experiencing, such as coughing, chest pain, or weight loss.
04
Provide information about any recent exposure to someone with active TB.
05
Sign and date the form to attest to the accuracy of the information provided.
Who needs tuberculin symptom screening form?
01
Individuals who have been potentially exposed to tuberculosis and are undergoing screening for the disease.
02
Healthcare workers who may come into contact with TB patients.
03
People living in congregate settings such as prisons or shelters where TB transmission can occur.
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What is tuberculin symptom screening form?
Tuberculin symptom screening form is a document used to assess individuals for signs and symptoms of tuberculosis.
Who is required to file tuberculin symptom screening form?
Individuals working in certain professions such as healthcare workers or those in close contact with high-risk populations are required to file tuberculin symptom screening form.
How to fill out tuberculin symptom screening form?
To fill out the tuberculin symptom screening form, individuals need to provide personal information, medical history, and undergo a physical examination.
What is the purpose of tuberculin symptom screening form?
The purpose of the tuberculin symptom screening form is to identify individuals who may have tuberculosis or be at risk for the disease.
What information must be reported on tuberculin symptom screening form?
The tuberculin symptom screening form requires information such as personal details, medical history, and the results of any tests or examinations.
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