Ppd Test Results Form PDF Details

Understanding the intricacies of the PPD Test Results form is crucial for medical professionals, patients, and anyone involved in tuberculosis screening and prevention. Introduced with the specific purpose of documenting the Mantoux Skin Test Result, this form meticulously captures the outcome of the 5TU-PPD-Tuberculin test, an essential tool in the early detection of tuberculosis infections. The form includes detailed sections for recording test administration and reading dates, the induration measured in millimeters, and the actions required for those with specific readings. Serving as a vital piece of the clinical puzzle, the form ensures that all relevant data, including situations where the test could not be administered or results are missing, is systematically captured and explained. Moreover, it highlights the importance of referral for clinical evaluation and/or treatment for participants with readings in a particular range, underscoring the form's role in not only documenting but also guiding subsequent healthcare interventions. With a version date of 10/01/99, the form remains a critical component in managing and tracking tuberculosis concerns, embodying a methodical approach to public health surveillance and individual patient care.

QuestionAnswer
Form NamePpd Test Results Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesforms for recording tabe test results, mantoux l8 form, online begin test page, printable ppd forms

Form Preview Example

ID LABEL HERE --->

LABORATORY - MANTOUX SKIN TEST RESULT

5TU-PPD-TUBERCULIN

FORM L8

|__| - |__|__| - |__|__|__|__| - |__|

VISIT #:

FORM COMPLETED BY:

___ ___

___ ___ ___

 

 

VERSION DATE: 10/01/99

ANY MISSING OR INCOMPLETE TEST RESULTS MUST BE EXPLAINED ON THIS FORM.

A1. 5TU-PPD-TUBERCULIN WAS:

 

 

DONE

1

(A2)

NOT DONE

2

 

____________________________

 

(END)

(SPECIFY REASON)

 

 

PARTICIPANT REFUSED

3

(END)

A2. DATE 5TU-PPD-TUBERCULIN PLACED:

 

 

/

 

 

 

/

 

 

 

M

 

D

 

 

Y

A3. DATE OF 5TU-PPD-TUBERCULIN READING:

 

 

/

 

 

 

/

 

 

 

M

 

D

 

 

Y

A4. RECORD MEASURED INDURATION OF 5TU-PPD-TUBERCULIN: |___|___|___| mm

NOTE: SERONEGATIVE PARTICIPANTS THAT HAVE A READING BETWEEN 5 MM AND

10 MM OF INDURATION REQUIRE A REFERRAL FOR CLINICAL EVALUATION

AND/OR TREATMENT.

WIHS Laboratory Form L8: Mantoux Skin Test Result - 5TU-PPD-Tuberculin - 10/01/99

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