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  • Appendix B Tuberculosis Tb Risk Assessment Worksheet

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09/27/2006 Centers for Disease Control and Prevention Division of Tuberculosis Elimination Appendix B. Tuberculosis (TB) risk assessment worksheet This model worksheet should be considered for use.

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Class B1 TB, Pulmonary. Applicants who have signs or symptoms, physical exam, or chest x-ray findings suggestive of tuberculosis disease, or have known HIV infection, but have negative AFB sputum smears and cultures and are not diagnosed with TB disease.

Miliary TB is a rare form of active disease that occurs when TB bacteria find their way into the bloodstream. In this form, the bacteria quickly spread all over the body in tiny nodules and affect multiple organs at once. This form of TB can be rapidly fatal.

A TB screening tool to be administered by licensed healthcare providers. Use this form to identify asymptomatic adults for latent TB infection (LTBI) testing. * Re-test persons who previously tested negative, and have new risk factors since the last assessment.

Tuberculosis (TB) is a contagious infection that usually attacks your lungs. It can also spread to other parts of your body, like your brain and spine. A type of bacteria called Mycobacterium tuberculosis causes it.

Active TB disease. Cough. Coughing up blood or mucus. Chest pain. Pain with breathing or coughing. Fever. Chills. Night sweats. Weight loss.

Have you ever had a positive TB skin test? Have you ever had close contact with anyone who was sick with TB? Have you ever been vaccinated with BCG? * The significance of the travel exposure should be discussed with a health care provider and evaluated.

For persons with TB symptoms,4 abnormal chest x-ray consistent with TB disease, or a positive TST or IGRA: Evaluate for active TB disease by obtaining a chest x-ray, symptom screen, performing a physical exam and if indicated,5 sputum testing (i.e., AFB smears, cultures and nucleic acid amplification).

Tuberculosis (TB) is caused by a type of bacterium called Mycobacterium tuberculosis. It's spread when a person with active TB disease in their lungs coughs or sneezes and someone else inhales the expelled droplets, which contain TB bacteria.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232