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The Engle Center for Counseling and Health Services One College Avenue, Suite 3028 Mechanicsburg, PA 17055 Phone: 7176916035 Fax 7177965372 Tuberculosis Skin Test Form Patient Name: Healthcare Professional:.

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Record Record the exact measurement in millimeters of induration on the Mantoux Tuberculin Skin Test Record Form. ... Record the date and time the test was read, the name and signature of the person who read the skin test, and the presence or absence of adverse effects (i.e., blistering, redness, and swelling)

A TB skin test measures your immune system's response to a purified protein derivative (PPD) solution injected under your skin. PPD is a protein that comes from the bacteria that causes TB — Mycobacterium tuberculosis. It's not live bacteria, and it won't make you sick.

Visually inspect injection site under good light, and measure induration (thickening of the skin), not erythema (reddening of the skin)....Reading Do not record as “positive” or “negative”. Only record measurement in millimetres. If no induration, record as 0 mm.

Alternate sites, such as the thigh, upper back, or shoulder may be used when the arms are not suitable. The injection is administered using a single-dose disposable tuberculin syringe that has a one-quarter to one-half inch, 25 to 27-gauge needle with a short bevel.

What is a 2-step TB skin test (TST)? Tuberculin Skin Test (TST) is a screening method developed to evaluate an individual's status for active Tuberculosis (TB) or Latent TB infection. A 2-Step TST is recommended for initial skin testing of adults who will be periodically retested, such as healthcare workers.

There are currently two methods for detecting tuberculosis infection: The Mantoux tuberculin skin test (TST) and an Gamma Release Assay (IGRA) blood test. Patients must be carefully assessed for risk factors PRIOR to administration of either test.

The diameter of the indurated area should be measured across the forearm (perpendicular to the long axis). Erythema (redness) should not be measured. Indurations should be recorded in millimeters, even those classified as negative. If no induration is found, "0 mm" should be recorded.

TST Documentation Requirements Name and signature of person administering test. Date and time test administered. Location of test (e.g., right forearm, left forearm, alternate site) Tuberculin manufacturer, lot number and expiration date.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232