Get Tuberculosis (tb) Risk Assessment Form - Moca Head Start

Filling out the Tuberculosis (TB) Risk Assessment Form - MOCA Head Start online is an important step in assessing your TB risk. This guide will provide clear instructions to ensure you can complete the form accurately and efficiently.

Follow the steps to complete the TB Risk Assessment Form online.

1. Click the ‘Get Form’ button to access the Tuberculosis (TB) Risk Assessment Form and open it in the designated editor.
2. Enter the patient's name in the designated field to identify the individual requiring assessment.
3. Provide the patient's date of birth in the specified format to ensure accurate age verification.
4. Fill in the date the assessment is being completed to maintain a record of the evaluation timeline.
5. Answer the questions in section A regarding past TB tests and vaccinations. Indicate 'Yes' or 'No' for each question.
6. In section B, assess TB risk factors. Answer whether there has been close contact with anyone sick with TB, travel history, or relevant medical conditions.
7. If applicable, provide information related to any abnormal chest x-ray results and medical conditions.
8. If any answers in section B are 'Yes', a medical evaluation might be necessary. Make sure to provide the required details in section C.
9. In section C, healthcare professionals will record additional tests such as TST or IGRA results. Ensure all fields are filled out with accuracy.
10. Collect sputum samples if indicated and document the required information, ensuring all collection criteria are met.
11. Sign and date the form in section D, confirming the information provided is true and complete.
12. After filling out the form, save your changes, then download, print, or share the form as needed according to your submission requirements.

Complete your Tuberculosis (TB) Risk Assessment Form online today to help ensure your health and safety.