Get Form D: Tb Symptoms Health Screening Checklist - Student Services - Studentservices Tu

Filling out Form D: TB Symptoms Health Screening Checklist is an important step in ensuring your health and safety in school. This guide will provide clear instructions to help you navigate each section of the form efficiently and effectively.

Follow the steps to complete the checklist accurately.

1. Press the ‘Get Form’ button to access the health screening checklist and open it in the document editor.
2. Begin by providing your 'Class of' details by selecting the appropriate checkbox for COM, COP, or MSPAS/MPH.
3. Clearly print your name in the designated field.
4. Indicate your gender by selecting the appropriate checkbox for Male or Female.
5. Enter the date of your PPD placement in the designated area.
6. Fill in your PPD results and include the millimeter measurement for induration.
7. If applicable, provide the date of the Quantiferon gold serum test.
8. If you have a history of a positive PPD or Quantiferon test, include the date of your last chest X-ray and its results.
9. Respond to the questions regarding active tuberculosis and any anti-TB medications you may have taken by checking 'Yes' or 'No' and listing any medication names if applicable.
10. Provide the date and duration of any medication regime you followed.
11. Indicate whether you have received a BCG vaccination, and if so, provide the date.
12. Answer the series of symptoms questions regarding weight loss, appetite changes, cough, sputum, night sweats, fever, fatigue, lymph node swelling, and family exposure to TB by checking 'Yes' or 'No.' For any 'Yes' answers, provide explanations in the space provided.
13. Sign and date the form as the student, ensuring all information is complete and clear.
14. Ensure the healthcare provider also signs and dates the form, confirming the accuracy of the information provided.
15. Once all sections are completed, save your changes, download, print, or share the filled-out form as needed.

Take action now to complete your health screening checklist online.