Get Tuberculosis Tb Symptom Screen - We Protect Lives

The Tuberculosis TB Symptom Screen - We Protect Lives is an essential document used for assessing potential tuberculosis symptoms. This guide will walk you through the process of completing the form online, ensuring that you can provide all necessary information accurately.

Follow the steps to successfully complete the TB symptom screen.

1. Click the ‘Get Form’ button to access the Tuberculosis TB Symptom Screen - We Protect Lives form and open it in your chosen document editor.
2. Begin by entering your name in the designated field, followed by selecting your sex by marking either 'M' or 'F'.
3. Fill in your date of birth in the appropriate section to provide age-related context for the assessment.
4. Complete the last skin test information by entering the name, address, city, state, zip code, and phone number of the facility where the test was conducted.
5. Record the test date and the results of the test by specifying the measurement in millimeters and checking the box for either positive or negative results.
6. Indicate whether you were treated for any conditions by checking the appropriate responses for chest x-ray results and any latent TB infection or TB disease you may have had, along with the duration of treatment.
7. Respond to the current health status questions, indicating if you have any symptoms such as cough, night sweats, fever, and more, by checking 'Yes' or 'No' and providing additional details as prompted.
8. If applicable, answer whether you know anyone with similar symptoms and provide their contact information if you answer 'Yes.'
9. In the action taken section, check all relevant boxes to signify the current state of your health and any measures that have been or need to be taken.
10. Finally, ensure the 'Signature of person conducting the assessment' and 'Signature of client' fields are properly signed. Add the date as required at the bottom of the form.
11. Once all fields have been filled out, make sure to save any changes, and then you can download, print, or share the completed form as necessary.

Complete your Tuberculosis TB Symptom Screen - We Protect Lives form online today to ensure your health and safety.