Get Kaiser Tb Referral Form 0428201712.doc

Filling out the KAISER TB Referral Form 0428201712.doc online is a crucial step for school staff and volunteers ensuring compliance with tuberculosis testing requirements. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently.

Follow the steps to successfully complete the KAISER TB referral form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your personal information in the designated fields. Fill in your last name, first name, phone number, and California worker identification number (CWID) accurately.
3. In the section titled ‘History of Tuberculosis Infection or Disease’, select the appropriate box indicating whether you have a documented history of positive TB test or TB disease.
4. For the ‘Risk Factors for Tuberculosis’ section, check any applicable risk factors that pertain to your situation. Each check box has specific implications for further evaluation.
5. Complete the ‘Services Requested’ section by checking the appropriate boxes for the services you require, particularly focusing on TB risk assessment.
6. Fill in the ‘Employee Name’, ‘Kaiser MR#’ (if available), address, home phone, work phone, last four digits of your social security number, date of birth, maiden name (if applicable), and gender.
7. After all fields are correctly filled out, review the entire form to ensure accuracy and completeness.
8. Finally, save changes, download, print, or share the form as necessary by following your preferred method of document management.

Ensure compliance with TB testing requirements by completing your KAISER TB referral form online today.