Follow the steps to effectively complete the assessment form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the patient's personal information, including their name, address, date of birth, race, and sex. Make sure to fill out the social security number and contact information accurately.
3. Indicate the patient's language preference and pregnancy status, if applicable. If they are pregnant, include the last menstrual period date.
4. Check all applicable symptoms under the 'Screen for TB Symptoms' section. If the patient reports no symptoms, select 'None' and proceed to the next section.
5. In the 'Screen for TB Infection Risk' section, indicate whether the patient has a history of BCG vaccination or prior TB tests. Document any relevant previous test results or treatments.
6. For 'Findings,' check all risk factors and past treatments, ensuring that you collect comprehensive information on the patient’s TB exposure history.
7. In the 'Action(s)' section, select the appropriate actions taken based on the assessment, such as referral for further evaluation or administering the TB skin test.
8. Complete the screening details, including the arm used and dates for the TB skin test placements and readings.
9. Ensure all required signatures are captured. The screener should sign and print their name, title, and contact information.
10. Review all entered information for accuracy, then save changes, download, print, or share the completed form as needed.

Begin filling out your Printable Employee Health Assessment Form online today.