Patient information, history of tuberculin test, current tuberculin PPD Mantoux tests, IGRA and X-rays, reason for testing, risk factors and medication.
Skin test reading: the client consents to a tuberculin skin test (TST) and understands the skin test is to be read in 48-72 hours by the designated reader/interpreter.
No return: if the client does not return in 48-72 hours, the TST may need to be readministered.
Live vaccinations: if the client had live vaccinations in the last four weeks, hold the TST for four weeks.
Page 2: Preventive Treatment Monitoring Continuation; please send to your local health department.
Treatment: CDC now recommends shorter courses of treatment for LTBI.
| Question | Answer |
|---|---|
| Form Name | Form MO 580-1589 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 404 |
| Avg. time to fill out | 60+ min |
| Edition | 12-19 |
| Issuing agency | Missouri Department of Health and Senior Services |
| Matches the agency's file | Yes, checked October 4, 2026 |
| Other names | MO 580-1589, MO 580 1589, TBC-4, Tuberculosis Testing Record |
| Official source | Form MO 580-1589 (Rev 12-19), Missouri Department of Health and Senior Services |
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