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Get PPD (Tuberculin Skin Test)

VANDERBILT UNIVERSITY MEDICAL CENTER The Digestive Disease Center The Inflammatory Bowel Disease Clinic PPD Tuberculin Skin Test Patient Name DOB VUMC MRN On // you received a PPD tuberculin skin test Injection given by Right Arm Left Arm TB Skin tests MUST be read by a healthcare provider within 48-72 hours or the test will need to be repeated. If given in VUMC clinic it must be documented in the Star Panel Immunization record of the chart. If read by a non-Vanderbilt clinic or provider please fill this form out and fax results to The Digestive Disease Center at 615 343-8174. VANDERBILT UNIVERSITY MEDICAL CENTER The Digestive Disease Center The Inflammatory Bowel Disease Clinic PPD Tuberculin Skin Test Patient Name DOB VUMC MRN On // you received a PPD tuberculin skin test Injection given by Right Arm Left Arm TB Skin tests MUST be read by a healthcare provider within 48-72 hours or the test will need to be repeated* If given in VUMC clinic it must be documented in the Star Panel Immunization record of the chart. If read by a non-Vanderbilt clinic or provider please fill this form out and fax results to The Digestive Disease Center at 615 343-8174. Results Negative Positive Induration Size If positive contact your Vanderbilt treating provider immediately. Reading healthcare provider documentation below Date Read Clinic Name Clinic Phone Clinic MD or NP Read By Signature RN/MD/NP Patient understand above instructions. If read by a non-Vanderbilt clinic or provider please fill this form out and fax results to The Digestive Disease Center at 615 343-8174. Results Negative Positive Induration Size If positive contact your Vanderbilt treating provider immediately. Results Negative Positive Induration Size If positive contact your Vanderbilt treating provider immediately. Reading healthcare provider documentation below Date Read Clinic Name Clinic Phone Clinic MD or NP Read By Signature RN/MD/NP Patient understand above instructions. If read by a non-Vanderbilt clinic or provider please fill this form out and fax results to The Digestive Disease Center at 615 343-8174. Results Negative Positive Induration Size If positive contact your Vanderbilt treating provider immediately. Reading healthcare provider documentation below Date Read Clinic Name Clinic Phone Clinic MD or NP Read By Signature RN/MD/NP Patient understand above instructions. .

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