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  • Record Of Tuberculosis Screening (dhhs 3405)

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1. Last NameFirst NameMI2. Patient Number 3. Date of Birth(MM/DD/YYYY)MonthDayYear 1. American Indian/Alaska Native 2. Asian 3. Black/African American 4. Native Hawaiian/ Other Pacic Islander 5. White.

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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.

Reading of the PPD Skin Test Erythema and induration are seen at the injection site. The diameter of induration is measured perpendicular to the long axis of the forearm, demarcated, and recorded in mm. Erythema or redness has no diagnostic value and should be ignored.

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.

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.

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)

To bill for placing the purified protein derivative (PPD) skin test for tuberculosis, use CPT®code 86580. Use this code when the nurse or medical assistant places the test on the patient's skin.

An induration of less than 5 millimeters (mm) is a negative result. If you have symptoms or know you've been exposed to someone with TB, a doctor may recommend you get another test. If the induration is at least 5 mm, it is considered positive in people who: have had recent contact with a person with TB.

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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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