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Get Latent Tuberculosis Infection Ltbi Questionnaire Please - Dphss Guam
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How to fill out the LATENT TUBERCULOSIS INFECTION LTBI QUESTIONNAIRE PLEASE - Dphss Guam online
This guide provides clear and supportive instructions on completing the Latent Tuberculosis Infection (LTBI) questionnaire online for individuals with a positive TB skin test. Follow the steps below to ensure that you accurately complete the form.
Follow the steps to successfully complete the LTBI questionnaire.
- Press the ‘Get Form’ button to access the LTBI questionnaire form and open it for editing.
- Begin by filling out your personal information, including your date of birth, name, and address. Ensure that your contact numbers are current and that you specify whether it is a home, work, or mobile number.
- Provide details regarding your ethnicity and record the information about your PPD skin test. This includes the dates the test was given and read, and the results measured in millimeters.
- Complete the section for the chest X-ray by noting the date of the exam and attaching a copy of the report. This is a crucial requirement.
- Indicate whether you have started treatment for LTBI and provide the date treatment began. If there are adverse reactions to the therapy, please check 'YES' or 'NO.'
- Specify if you have been exposed to active TB and check the symptoms you may have experienced. If you check 'YES' for any symptoms, note that a repeat chest X-ray is needed before referral.
- Attach findings from the repeat X-ray report and ensure to indicate whether it was normal or abnormal.
- Determine if you are cleared for work or school and indicate whether you need a referral to the Department of Public Health.
- Finally, ensure the form is signed by the physician and includes their name and stamp for verification. Do not forget to note the date, as this form is valid for 90 days.
- After filling in all required fields and attaching any necessary documents, save the changes, and proceed to download or print the completed form for your records.
Ensure that you complete your LTBI documentation online accurately and in a timely manner.
Persons with latent TB infection are not infectious and cannot spread TB infection to others. Overall, without treatment, about 5 to 10% of infected persons will develop TB disease at some time in their lives. About half of those people who develop TB will do so within the first two years of infection.
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