Mantoux Test Report Format Form PDF Details

Understanding the Mantoux Test Report Format is crucial, especially for students and healthcare professionals. This specific form is designed to document the administration and results of the Tuberculosis (TB) skin test, commonly known as the Mantoux Test. It requires the student's name, UF-ID, and signature to ensure proper identification and consent. The form is distinctive because it caters to a two-step TB test process, indispensable in accurately determining TB exposure. It includes sections for recording the dates the tests were administered and read, the results (positive or negative), and the signatures of the health care providers who administered the tests. Furthermore, it addresses scenarios where a TB skin test cannot be performed due to a past positive PPD test or BCG vaccination, recommending a chest x-ray or a physician's statement instead. This documentation is pivotal not just for the immediate health and safety concerns, but also for compliance with regulations in certain educational or professional settings, illustrating the blend of medical prudence and regulatory adherence.

QuestionAnswer
Form NameMantoux Test Report Format Form
Form Length1 pages
Fillable?Yes
Fillable fields19
Avg. time to fill out4 min 3 sec
Other namesmantoux test report format pdf, mantoux test report pdf, mantoux test report format, mantoux report writing format

Form Preview Example

2 Step TB form

_________________________________________

_____________________________

Student Name (Print)

UF-ID

________________________________________

 

Student Signature

 

Please submit the documentation about TB status by letterhead, official form, or this College of Pharmacy form.

TB Skin Test #1

_________________

 

 

___________________________________

Date Given

 

 

Health Care Provider Signature

_________________

Circle One:

 

___________________________________

Date Read

Positive

Negative

Health Care Provider Signature

 

______________mm

 

TB Skin Test #2

_________________

 

 

___________________________________

Date Given

 

 

Health Care Provider Signature

_________________

Circle One:

 

___________________________________

Date Read

Positive

Negative

Health Care Provider Signature

______________mm

Important Note: If a TB skin test cannot be performed due past positive PPD tests or BCG vaccination, please either have a chest x-ray done with results interpreted or a statement from a physician on office letterhead that you are free from TB and do not need a two step TB skin test or chest x-ray.

Chest X-ray

_________________

Circle One:

 

___________________________________

Date Read

Positive

Negative

Health Care Provider Signature

H:\group\Student Affairs\Background Checks & DATA COLLECTION\TB\2-Step TB form.doc

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This document requires specific info to be typed in, thus make sure to take some time to provide what is required:

1. It is very important fill out the motax test report result properly, therefore take care when filling out the parts containing these particular fields:

The way to fill out report format stage 1

2. Once this section is finished, you'll want to insert the required specifics in TB Skin Test Date Given Date, Health Care Provider Signature, Circle One Positive, Negative, Health Care Provider Signature, Important Note If a TB skin test, Health Care Provider Signature, Circle One Positive, and Negative so you're able to move forward to the third step.

Writing part 2 of report format

As to Negative and Health Care Provider Signature, ensure you don't make any errors here. Both these are surely the most significant ones in the page.

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