Get Screening Of Tuberculosisvaccine Preventable Diseases - Csulb
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How to fill out the Screening Of Tuberculosis/Vaccine Preventable Diseases - Csulb online
Filling out the Screening Of Tuberculosis/Vaccine Preventable Diseases form online is a crucial step in ensuring public health and safety. This guide provides clear, step-by-step instructions to help you complete the form accurately and efficiently.
Follow the steps to accurately complete the form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your personal information in section 1. Include your first name, middle initial, and last name, ensuring that all information is typed or printed clearly.
- Select your gender by marking the appropriate checkbox: Male or Female.
- Provide your birthdate by entering the full date in the designated field.
- Enter the last six digits of your social security number.
- Indicate your TB screening type by selecting one of the options: ‘Annual’, ‘New employee’, or ‘Non-employee TB screening’.
- In section 2, if you have prior tuberculosis screening history, provide the required details as specified. If you have had a prior positive TST, indicate the date and the measurement of induration.
- For section 3, fill in details regarding the TST administration including the name of the administering health care provider, lot number, and expiration date.
- Document the results of the test, including the date it was read, the amount of induration measured in millimeters, and the interpretation (significant or non-significant).
- In section 4, check if you are experiencing any symptoms of tuberculosis and mark all applicable symptoms. Include the date of this evaluation.
- Section 5 pertains to the chest X-ray (CXR). If a CXR is needed, indicate that in the form and document the CXR results as appropriate.
- Complete section 6 by checking the appropriate results of the CXR, if required.
- Once all sections are completed, in section 7, ensure the evaluator's name, signature, and date are clearly written.
- Finally, save your changes, print, or share the document as needed, ensuring that you keep a copy for your records.
Complete the Screening Of Tuberculosis/Vaccine Preventable Diseases form online to contribute to a healthier community.
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