Get Tb Annual Symptom Review - Sjsu

Filling out the TB Annual Symptom Review is an essential process for SJSU nursing students testing positive on the PPD tuberculin skin test. This guide provides a clear and supportive approach to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the TB Annual Symptom Review online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part 1 of the form, which you, as the student, will complete before visiting a health care provider. Review each symptom listed and select ‘Yes’ or ‘No’ for the symptoms you are currently experiencing, including cough, fever, and night sweats.
3. If you have answered ‘Yes’ to any symptoms, provide additional information regarding when the symptoms first began, how long you have been experiencing them, and if you have been evaluated by a physician. This should be documented in the space provided.
4. Next, answer the question regarding anyone in your household exhibiting similar symptoms. If applicable, list the symptoms as instructed.
5. Indicate whether you have had a chest x-ray to rule out tuberculosis. If the answer is ‘Yes’, provide the date of the x-ray, the physician’s name, and their contact information.
6. Answer whether you have received medication for active tuberculosis disease or preventive treatment, specifying the names of the medications, and the timeline of treatment if applicable.
7. At the bottom of the section, provide your signature and the date to confirm the information presented is accurate and complete.
8. Part 2 of the form needs to be completed by a health care provider. Ensure they fill in their printed or typed name, health care agency affiliation, and their signature along with the date.
9. Complete the assessment section and note any required follow-up instructions as indicated by the health care provider.
10. Once all parts of the form are filled, you can save changes, download, print, or share the document as necessary.

Take the necessary steps to complete the TB Annual Symptom Review online today.