Edit, Download, and Sign the Tuberculosis/Mantoux Skin Testing Form
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How do I fill this out?
To fill out this form, read the information and consent section thoroughly. Complete the risk assessment by answering the questions truthfully. Submit the form for PPD administration and follow-up.
How to fill out the Tuberculosis/Mantoux Skin Testing Form?
1
Read the information and consent section.
2
Answer the risk assessment questions truthfully.
3
Submit the form for PPD administration.
4
Return for test reading in 2-3 days.
5
Follow up as necessary based on test results.
Who needs the Tuberculosis/Mantoux Skin Testing Form?
1
Health care workers who require regular TB screening.
2
Individuals who have been exposed to TB and need testing.
3
New employees in health care settings who need initial TB screening.
4
Employees with recent exposure to TB who need follow-up testing.
5
Patients and individuals at risk of TB who need monitoring.
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Submit or share your finalized document.
What are the instructions for submitting this form?
Submit this form by emailing it to TBTesting@healthcenter.unt.edu or faxing it to (123) 456-7890. You can also submit it online via the health center's website or drop it off at the physical address: UNT Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX 76107. Ensure all sections are completed and the form is signed before submission. My advice is to retain a copy for your records and follow up as required.
What are the important dates for this form in 2024 and 2025?
Important dates for this form include test administration dates and follow-up dates for reading results. Ensure you adhere to the 2-3 day window for test reading.
What is the purpose of this form?
The purpose of this form is to facilitate Tuberculosis skin testing for health care workers and individuals at risk. The form includes sections for information and consent, risk assessment, test administration, and referral if necessary. By following the instructions and completing the form accurately, health care workers can ensure proper monitoring and intervention for Tuberculosis prevention and control.
Tell me about this form and its components and fields line-by-line.
- 1. Name (print): The full name of the individual undergoing the TB test.
- 2. Department: The department where the individual works or is affiliated.
- 3. Signature: The signature of the individual giving consent for the TB test.
- 4. School (Class/Year): The school and class/year details for the individual.
- 5. Date: The date when the form is completed and signed.
- 6. Risk Assessment Questions: A series of yes/no questions to assess TB risk and history.
- 7. PPD Administration Details: Details of the test administration including dates, lot numbers, and administrators' signatures.
- 8. Interpretation and Referral: Results interpretation and necessary referrals for positive indications.
What happens if I fail to submit this form?
Failure to submit this form can result in missed TB testing and delayed medical intervention. It's crucial to submit the form for timely diagnosis and follow-up.
- Missed Testing: Not submitting the form can lead to missing the TB test schedule.
- Delayed Intervention: Delays in detecting and treating TB due to missing submissions.
- Inaccurate Records: Health records may be incomplete or inaccurate without the form's submission.
How do I know when to use this form?
- 1. Initial TB Screening: New health care workers must complete this form for their initial TB screening.
- 2. Follow-up Testing: Those who have been exposed to TB must use this form for follow-up testing.
- 3. Annual Assessment: Health care workers need to fill out this form annually for regular TB screening.
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How do I know when to use this form?
This form is used for TB screening, post-exposure testing, and regular health assessments in health care settings.
What if I miss the follow-up date after the test is administered?
You may need to repeat the test if you miss the follow-up date. Ensure to adhere to the timelines provided.
Can I fill out the form for someone else?
It is recommended that the individual being tested fills out the form themselves to ensure accuracy in the information provided.
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