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Get Tb Xray Ala Moana Form
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How to fill out the Tb Xray Ala Moana Form online
Filling out the Tb Xray Ala Moana Form online is a straightforward process that can help ensure your health information is submitted efficiently. This guide will provide you with step-by-step instructions to complete the form correctly.
Follow the steps to fill out the Tb Xray Ala Moana Form online.
- Click ‘Get Form’ button to obtain the form and open it in the designated online editor.
- Begin filling out your personal information. Start by entering your name in the format of last name, first name, and middle name. Make sure to type or print clearly.
- Indicate your sex by selecting the appropriate option provided.
- Enter your date of birth using the format requested in the form.
- Fill in your street address, including any apartment number. Then, provide your city, state, and ZIP code.
- If your mailing address differs from your street address, complete the mailing address section, including city, state, and ZIP code.
- You will need to sign your name in ink as it appears on your application. This signature must be done in the presence of the examining physician for identification purposes.
- Next, provide details regarding the tuberculosis test. Enter the date of the test result and circle the type of test conducted — skin test or X-ray. Then, indicate the result of the test.
- Obtain the signature of the licensed medical provider who performed the test. Include the date, their printed name, title, and the business name and address.
- Provide similar details for the syphilis blood test section. Enter the date of the result, type of test, and result.
- Lastly, obtain the signature of the licensed medical provider for the syphilis test, along with the necessary details about them and their business.
- Once all sections are filled out, review your entries for any errors. Save your changes, and then download, print, or share the completed form as necessary.
Start your online submission of the Tb Xray Ala Moana Form today for efficient document management!
Related links form
Getting a chest X-ray for TB necessitates making an appointment with your healthcare provider to discuss your symptoms and receive a referral. They will guide you through the process, which may include filling out a Tb Xray Ala Moana Form before heading to the imaging facility. Being organized will help expedite your care.
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