Get Printable Tb Questionnaire

The Printable Tb Questionnaire is an essential tool for assessing and documenting an individual's symptoms and risk factors related to tuberculosis. This guide offers clear and comprehensive instructions to assist users in completing the questionnaire online effectively and accurately.

Follow the steps to successfully complete the Printable Tb Questionnaire.

1. Click the ‘Get Form’ button to obtain the Printable Tb Questionnaire and open it in your preferred form editor.
2. Begin by entering the patient's personal information. This includes the patient's name, address, home and work telephone numbers, date of birth, sex, and social security number. Be sure to provide accurate information as it is crucial for proper assessment.
3. Next, fill in the ethnicity, race, and country of birth of the patient. This information aids in identifying potential risk factors associated with TB.
4. Indicate the year of arrival in the U.S. if applicable and list the languages spoken. If an interpreter is needed for communication, please mark 'Yes' or 'No' accordingly.
5. Assess the patient's pregnancy status by indicating 'Yes' or 'No.' This is important as it may impact the management of their TB evaluation.
6. Document any history of prior BCG vaccination and specify the year if applicable. This information can influence the test results.
7. Outline any known drug allergies. Additionally, if relevant, provide the last menstrual period date.
8. In Section I, screen for TB symptoms. Indicate any symptoms experienced by the patient and evaluate their severity accordingly.
9. For patients with a history of TB treatment, provide details about prior tests, treatments, and vaccines related to TB.
10. Proceed to Section II to assess TB infection risk. Check all applicable risk factors based on the provided categories.
11. In Section III, check all findings that apply based on previous assessments. This will guide further action.
12. In Section IV, indicate all actions taken as a result of the findings. Provide required details about TB skin tests administered and any follow-up needed.
13. Once all sections are completed, review the information for accuracy. After confirming the details are correct, you can save, download, print, or share the questionnaire as needed.

Complete the Printable Tb Questionnaire online today to ensure a thorough assessment of tuberculosis risk.