Get Mantoux Test Report

Filling out the Mantoux Test Report online can streamline the reporting process for healthcare providers. This guide provides step-by-step instructions to ensure accurate and timely completion of the form.

Follow the steps to accurately complete the Mantoux Test Report online.

1. Click ‘Get Form’ button to obtain the Mantoux Test Report and open it in your preferred editor.
2. Enter the patient's surname in the designated field. Ensure that the name is spelled correctly and is legible.
3. Input the patient's first name in the next section, ensuring clarity and proper spelling.
4. Fill in the patient's date of birth using the format year/month/day (y/m/d). Verify the date for accuracy.
5. Select the gender of the patient by checking the appropriate box: [ ] M [ ] F.
6. In the phone section, provide the home phone number in the designated field followed by the work phone number if applicable.
7. Complete the address section by entering the full residential address of the patient.
8. Fill in the Mantoux test details, including the date the test was given and the date it was read. Again, use the year/month/day format.
9. Record the results of the Mantoux test in millimeters (mm) in the specified field.
10. If a chest X-ray was conducted, enter the results in the appropriate section along with the date.
11. If applicable, provide results from any sputum smear tests related to respiratory symptoms.
12. Indicate whether the patient is a known contact of tuberculosis (TB) by selecting 'Yes' or 'No'.
13. If anti-tuberculosis medication is prescribed, attach the prescription and mention if the medication is contraindicated or not prescribed, along with the reason.
14. Provide the printed name of the physician completing the report along with their address and phone number.
15. Finally, fill in the date the form is completed, sign it, and ensure all information is accurate before submission.
16. Once completed, save your changes, and opt to download, print, or share the form as necessary.

Complete your Mantoux Test Report online today to ensure timely reporting and follow-up.