Tb Screening Form PDF Details

Have you ever had a chest x-ray? If so, you may be familiar with the TB screening form that is usually given to patients. This form is used to screen for tuberculosis (TB), a serious respiratory infection. Although TB is not as common in the United States as it is in other parts of the world, it still poses a significant threat to public health. In this blog post, we will discuss the basics of TB screening and how it can be used to protect your health. We will also explore some of the myths and misconceptions about TB screening.

This figure offers specifics of tb screening form. Before you decide to complete the form, it can be definitely worth reading more details on it.

QuestionAnswer
Form NameTb Screening Form
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesbureau tuberculosis screening form, blank pasrr form, tb forms, tb screening form pdf

Form Preview Example

LEHIGH UNIVERSITY HEALTH & WELLNESS CENTER/ BETHLEHEM HEALTH BUREAU

TUBERCULOSIS (TB) SCREENING FORM

First Name _______________________________

Last Name _______________________________________

Student ID# ______________________________

 

Cell Phone _______________________________

E-mail___________________________________________

Date of Birth _____________________________

Country of Birth___________________________________

____Undergraduate _____Graduate_____ESL_____Other

________________________________________________________________________________________

PLEASE ANSWER THE FOLLOWING QUESTIONS:

 

 

1.

Have you ever had a positive TB (Tuberculosis) skin test (PPD)?

Yes

No

2.

Have you ever had a positive TB blood test (Quantiferon GOLD)?

Yes

No

3.

Have you ever had close contact with anyone who was sick with TB?

Yes

No

4.

Were you born in one of the countries listed below?

Yes

No

5.

Have you ever had an extended stay, 6 months or more, in any of the following

 

 

 

areas with a high prevalence of TB as defined by the World Health Organization? Yes

No

Africa – all countries

Asia/Southeast Asia/Pacific Islands – all countries

North, Central & South America – Argentina, Bahamas, Belize, Bolivia, Brazil, Costa Rica, Columbia, Dominican Republic, Ecuador, El Salvador, Guatemala, Guyana, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Venezuela

Europe – Belarus, Bosnia, Herzegovina, Bulgaria, Croatia, Estonia, Hungary, Latvia, Lithuania, Macedonia, Moldova, Poland, Portugal, Romania, Russian Federations, Serbia, Slovak Republic, Slovenia, Ukraine, Yugoslavia

Middle East – Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Syrian Arab Republic, Turkey, Yemen

KRS 03/08/12

How to Edit Tb Screening Form Online for Free

The procedure of filling in the printable tb questionnaire is actually hassle-free. We made certain our PDF editor is not hard to work with and helps complete any document in a short time. Here are just several simple steps you have to follow:

Step 1: Choose the button "Get Form Here" and then click it.

Step 2: You're now ready to manage printable tb questionnaire. You have numerous options with our multifunctional toolbar - you can include, eliminate, or alter the text, highlight the certain parts, and carry out similar commands.

The PDF form you wish to fill out will consist of the next sections:

stage 1 to writing fillable pdf tb screening form

Enter the requested details in Have you ever had a positive TB, Yes, Have you ever had close contact, Yes, Were you born in one of the, Yes, Have you ever had an extended, areas with a high prevalence of TB, Africa all countries, Europe Belarus Bosnia, Macedonia Moldova Poland Portugal, Middle East Bahrain Iran Iraq, and Syrian Arab Republic Turkey Yemen box.

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Step 4: Be sure to generate as many copies of your document as possible to stay away from potential misunderstandings.

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