Get Tuberculosis (tb) Screening Form - Pace

Filling out the Tuberculosis (TB) Screening Form - Pace is an essential step in evaluating potential TB risk for both individuals and public health. This guide provides clear, step-by-step instructions to assist you in completing the form accurately and efficiently.

Follow the steps to complete your TB screening form with ease.

1. Click ‘Get Form’ button to access the Tuberculosis (TB) Screening Form - Pace and open it for completion.
2. Enter today's date in the format: month/day/year.
3. In the self-assessment section, provide your full name (last, first, and middle), date of birth, address, and phone numbers. Ensure all information is accurate.
4. Answer the questions regarding your TB history, including previous skin tests, chest x-rays, treatment for TB, and potential exposure to someone with TB. Provide dates and details where applicable.
5. Indicate any relevant medical history, such as cancers, organ transplants, or other conditions that may affect your immune system.
6. Report any symptoms consistent with TB and include the date you first noticed any of these symptoms if applicable.
7. Complete the questions about your travel history, living arrangements, and any visitors from outside the U.S., including dates and locations.
8. Sign and date the form as the patient or a parent/guardian, indicating agreement with the provided information.
9. If required by the clinic, the clinician will complete the assessment outcome and TB test administration sections. They will document the results and any necessary follow-ups.
10. Review all entered information for accuracy. Save your changes, and you may choose to download, print, or share the form as needed.

Complete your Tuberculosis (TB) Screening Form online today to ensure your health and safety.