PPD Skin Test Form PDF Details

The PPD skin test form is used to determine if someone has a sensitivity to the tuberculosis (TB) vaccine. The test is administered by pricking the skin on the arm and injecting a small amount of PPD tuberculin. If a red bump forms within 48-72 hours, it indicates that the person has a sensitivity to the vaccine. A positive reaction does not necessarily mean that you have TB, but it does indicate that you are at risk for developing the disease. Talk to your doctor about whether or not you should get vaccinated against TB.

In the table, there is some information about the ppd skin test form. It's advised that you read through this information before you begin filling out the file.

Form Name Ppd Skin Test Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names ppd test record form, tb test record form, ppd test record, ppd record form

Form Preview Example



Name: _____________________________________________________________________

Address: ___________________________________________________________________

City/Town: ______________________ State: ________________ Zip: _________________

Telephone: ____________________________



Cell or Work


Student ID #: __________________________ Class of: _____________________________


Administrator Name: __________________________________________________________

Date/time Administered: _______________________________________________________

Arm on which Administered: ___________________________________________________

Manufacturer of PPD Solution: __________________________________________________

Expiration Date of PPD Solution: ________________________________________________

Lot #: __________________


Induration: ___________________mm Date/time of Reading: ____________________

Comments and Adverse Reaction(s), if any: ______________________________________


Printed Name and Title (MD/RN/MA) of Reader: __________________________________

HealthCare Provider Signature:____________________________ Date:_____/_____/______

Updated 11/13 OR

How to Edit PPD Skin Test Form Online for Free

Filling out the tb documentation form is not difficult using our PDF editor. Follow the next steps to create the document straight away.

Step 1: You should select the orange "Get Form Now" button at the top of the web page.

Step 2: So you are on the form editing page. You may edit and add text to the document, highlight specified content, cross or check certain words, include images, insert a signature on it, get rid of unneeded fields, or eliminate them completely.

Create the tb documentation PDF and type in the information for each and every section:

stage 1 to completing ppd record template

The software will demand you to fill out the Arm on which Administered, Manufacturer of PPD Solution, Expiration Date of PPD Solution, Lot, Results, Induration mm Datetime of Reading, Comments and Adverse Reactions if, Printed Name and Title MDRNMA of, and HealthCare Provider Signature Date segment.

step 2 to entering details in ppd record template

Step 3: Choose the button "Done". Your PDF form may be exported. You can easily upload it to your pc or send it by email.

Step 4: Come up with a duplicate of each separate document. It should save you time and allow you to keep clear of problems in the future. Also, your data won't be distributed or monitored by us.

Watch PPD Skin Test Form Video Instruction

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