Get the free Tuberculosis Screening Form

This form is required for students entering the School of Health Sciences at Cleveland State University to document tuberculosis screening results, including the two-step TB Mantoux Test, Quantiferon

How to fill out tuberculosis screening form

How to fill out tuberculosis screening form

1. Gather personal information such as your name, address, and date of birth.
2. Indicate your reason for screening, such as travel history or recent exposure.
3. Answer health-related questions regarding symptoms like cough, fever, and weight loss.
4. Provide details on your medical history, including any previous tuberculosis infections or treatments.
5. Fill out any sections related to employment or school requirements if applicable.
6. Review the completed form for accuracy and completeness.
7. Submit the form to the designated healthcare provider or clinic.

Who needs tuberculosis screening form?

1. Individuals who have been in close contact with someone diagnosed with tuberculosis.
2. People who show symptoms of tuberculosis, such as persistent cough or fever.
3. Travelers going to areas with high rates of tuberculosis.
4. Persons with compromised immune systems, such as those with HIV/AIDS.
5. Healthcare workers who are exposed to high-risk populations.

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What is tuberculosis screening form?

The tuberculosis screening form is a document used to collect information about an individual's risk of tuberculosis (TB) infection and exposure, which helps in deciding whether further testing or treatment is needed.

Who is required to file tuberculosis screening form?

Individuals who are at risk for tuberculosis, such as healthcare workers, immigrants from high-prevalence countries, or those exhibiting symptoms of TB, are typically required to file a tuberculosis screening form.

How to fill out tuberculosis screening form?

To fill out the tuberculosis screening form, individuals must provide personal information, including their name, contact details, medical history, and answers to specific questions regarding TB exposure and symptoms. It is important to complete all sections accurately.

What is the purpose of tuberculosis screening form?

The purpose of the tuberculosis screening form is to assess an individual's risk of TB infection, identify potential exposure, and determine the need for further diagnostic testing or preventive treatment.

What information must be reported on tuberculosis screening form?

The tuberculosis screening form typically requires reporting of personal identification details, medical history related to TB exposure, symptoms such as cough or fever, and any previous TB diagnoses or treatments.