Get Tuberculosis (TB) Screening Questionnaire Printed Name: CMU # Signature: Date Please Answer The

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.

Have you ever had a positive TB skin test? Have you ever been vaccinated with BCG? Have you ever had close contact with persons known or suspected to have active TB disease?

To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use CPT®code 86580.

Background: Since 2011, WHO recommends a four-symptom screening rule to exclude active tuberculosis in people living with HIV before starting tuberculosis preventive treatment (ie, absence of current cough, weight loss, night sweats, or fever).

The purpose of this tool is to identify adults with infectious tuberculosis (TB) to prevent them from spreading disease. Do not repeat testing unless there are new risk factors since the last negative test.

The TB skin test is performed by injecting a small amount of fluid (called tuberculin) into the skin on the lower part of the arm. A person given the tuberculin skin test must return within 48 to 72 hours to have a trained health care worker look for a reaction on the arm.