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Get Record Of Tuberculosis Screening (dhhs 3405)
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How to fill out the Record Of Tuberculosis Screening (DHHS 3405) online
Filling out the Record Of Tuberculosis Screening (DHHS 3405) online is an essential step in documenting an individual’s tuberculosis status. This guide provides clear instructions for completing each section of the form, ensuring accuracy and compliance.
Follow the steps to complete the Record Of Tuberculosis Screening online.
- Locate and select the 'Get Form' button to access the Record Of Tuberculosis Screening (DHHS 3405). This will open the form in a digital format, allowing for easier completion.
- In the first section, fill in your last name, first name, and middle initial. This information is crucial for identifying the individual for whom the screening is being recorded.
- Next, enter the patient number, followed by the date of birth in the specified format (MM/DD/YYYY). Ensure the date is accurate to avoid any discrepancies.
- Indicate the appropriate race by selecting from the listed options. Mark the box next to your ethnicity status as 'Hispanic or Latino Origin' by selecting 'Yes', 'No', or 'Unknown'.
- Specify the gender by selecting the appropriate option, either 'Female' or 'Male'.
- Input your county of residence to provide information regarding your local jurisdiction.
- In Section A, answer all health-related questions regarding symptoms associated with tuberculosis. Select 'Yes' or 'No' for each item based on your current health status.
- If all answers in Section A are 'No', sign the statement confirming the accuracy of your health statement and write the date beside your signature.
- If two or more answers are 'Yes', do not complete the record in this section. Seek further evaluation as instructed.
- For Section B, a licensed medical professional must provide details of the tuberculin skin test or IGRA, chest X-ray, and confirm the absence of tuberculosis symptoms.
- Finally, save any changes made to this form. You can download, print, or share the Record Of Tuberculosis Screening as needed, depending on how you plan to submit or retain the document.
Complete the Record Of Tuberculosis Screening online to effectively document your health status.
How is the TST Read? The skin test reaction should be read between 48 and 72 hours after administration by a health care worker trained to read TST results. A patient who does not return within 72 hours will need to be rescheduled for another skin test.