Two Step Tb Test Form Template PDF Details

Tb is a serious issue that can impact people of all ages. If you are concerned that you may have tb, it is important to get tested as soon as possible. The two step tb test form template makes the process easy and convenient. Simply fill out the form and take it to your nearest clinic or hospital for testing. Getting tested is the best way to determine whether or not you have tb and to begin treatment if needed.

If you need to know a number of specific details pertaining to the file you'll use, here's the data you might like to study before filling out the two step tb test form template.

Form NameTwo Step Tb Test Form Template
Form Length1 pages
Fillable fields21
Avg. time to fill out4 min 31 sec
Other names2 step ppd form, printable 2 step ppd form, 2 step tb test form, tb test form

Form Preview Example

Initial Two-Step Tuberculin Skin Test Report Form

College of Saint Benedict/Saint John’s University – Department of Nursing

The deadline for submission is August 15. Please email a scanned copy to and keep a copy for your records.

Student Information (please print)



Last Name


Clinic Information




Clinic Name

City, State


PLEASE NOTE: If the student has recently traveled to a TB high-risk area, he/she must complete a TB Symptom Screening Form by August 15. The two-step PPD and this form can then be completed 8-10 weeks after returning to the U.S.

Two-step PPD (Mantoux)

NOTE: QuantiFERON blood test, tine, or monovac are not acceptable.


Date Given: _______________

Signature/Title: ___________________________________

Date Read: ________________

Signature/Title: ___________________________________

Step 1 Results: _____mm

Interpretation: Negative


* Results must be read within 48-72 hours by trained personnel.





Date Given: _______________

Signature/Title: ___________________________________

Date Read: ________________

Signature/Title: ___________________________________

Step 2 Results: _____mm

Interpretation: Negative


*Results must be read within 48-72 hours by trained personnel.

Previous or current positive PPD or received BCG

A chest x-ray is required within two years and screened for absence of active TB symptoms.

Chest x-ray date: __________________ Results: Negative Positive

Medical Treatment Plan: ____________________________________________________

Student can cannot participate in providing patient care in all clinical areas.

Provider Signature/Title: __________________________________________________

This information is strictly CONFIDENTIAL and is used to comply with contractual requirements of clinical agencies. Information supplied will become a part of your health record; it will not influence your standing at the college, and it will not be released to anyone except by your written authorization.

How to Edit Two Step Tb Test Form Template Online for Free

Filling in files using our PDF editor is more straightforward as compared to anything else. To edit tb test 2 step form printable the document, there is nothing for you to do - merely continue with the actions down below:

Step 1: To begin the process, select the orange button "Get Form Now".

Step 2: When you have accessed the editing page tb test 2 step form printable, you should be able to see all the actions readily available for the document inside the top menu.

You should provide the next information to complete the tb test 2 step form printable PDF:

2 step ppd form fields to complete

In the Date, Given, Signature, Title and Date, Read, Signature, Title field, note down your information.

2 step ppd form DateGivenSignatureTitle, and DateReadSignatureTitle blanks to complete

Step 3: Press the Done button to confirm that your completed file may be exported to any type of gadget you use or sent to an email you indicate.

Step 4: To prevent probable forthcoming complications, it's recommended to possess at the very least a couple of copies of every file.

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