TB Skin Test Form PDF Details

Discussing the Tuberculosis Skin Test Form sheds light on an essential health requirement found in various settings, from schools to workplaces. This form is meticulously designed to record critical details of the TB skin test—a screening to detect tuberculosis infection. It requires the healthcare professional or patient's name, pinpointing the testing location and the exact placement date, important for ensuring the test's validity. The test can be administered on either the right or left forearm, a choice meticulously documented alongside information like the Lot number of the TB test used and its expiration date, underscoring the test's reliability. The signature of the healthcare provider, be it a registered nurse, doctor, or other, finalizes the administration section. Reading the test results falls within a specific timeframe—48 to 72 hours after administration—to confirm accuracy, captured along with the size of the induration measured in millimeters. This dimension helps determine a negative or positive result, which is then signed off by the responsible healthcare professional. Accuracy and completeness in filling out each section are paramount, as an incomplete form may not be considered valid. This comprehensive approach ensures the TB Test Form fulfills its pivotal role in public health and safety.

QuestionAnswer
Form Name Tb Test Form
Form Length 1 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 15 sec
Other names tb test forms, blank tuberculosis forms for employment, ppd form, tb skin form

How to Fill Out Tuberculosis Skin Test Form

Tuberculosis Skin Test Form at a glance

What it is: The PPD (Mantoux) Test Result on the Tuberculosis Skin Test Form is Negative or Positive.

Who signs: If you administered it, sign the Signature (administered by) line; if you read or reported the results, sign the Signature (results read/reported by) line.

A filled-in Tuberculosis Skin Test Form example: a nurse records a negative test

Tuberculosis Skin Test Form example filled out, example: a nurse records a negative test
Alex Sample is the person tested. Dana Sample, an RN, administers and reads the test, so RN is ticked in both signature rows. The test is read 48 hours after placement with 0 mm induration and a negative result. The picture shows page 1, and none of its entries is real. The Left box under Site is ticked, so Right stays empty. Negative is ticked, so Positive stays empty.

How to fill out Tuberculosis Skin Test Form, box by box

Healthcare Professional/Patient Name, Testing Location and Date Placed

Tuberculosis Skin Test Form example filled out, healthcare Professional/Patient Name, Testing Location and Date Placed

Enter the Healthcare Professional/Patient Name, the Testing Location and the Date Placed.

Site, Lot # and Expiration Date

Tuberculosis Skin Test Form example filled out, site, Lot # and Expiration Date

Under Site, mark Right or Left. Then enter the Lot # and the Expiration Date.

Signature (administered by)

Tuberculosis Skin Test Form example filled out, signature (administered by)

Sign on the Signature (administered by) line and mark RN, MD or Other.

Date Read, Induration and PPD (Mantoux) Test Result

Tuberculosis Skin Test Form example filled out, date Read, Induration and PPD (Mantoux) Test Result

Enter the Date Read within 48-72 hours from date placed, and the Induration in mm.

Under PPD (Mantoux) Test Result, mark Negative or Positive.

Signature (results read/reported by)

Tuberculosis Skin Test Form example filled out, signature (results read/reported by)

Sign on the Signature (results read/reported by) line and mark RN, MD or Other.

More rules for Tuberculosis Skin Test Form

In order for this document to be valid/acceptable, all sections of this form must be completed.

Common questions about Tuberculosis Skin Test Form

Is there a deadline?

Date Read is within 48-72 hours from date placed.

Sources

[1] Tuberculosis Skin Test Form (the served file; no issuer file) (the Official source link on this page).

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