Get Hi Tuberculosis And Syphilis Report Form 2016-2025

Filling out the HI Tuberculosis And Syphilis Report Form online is a straightforward process that ensures the accurate reporting of essential health information. This guide provides detailed steps to help users complete the form effectively.

Follow the steps to successfully complete the form online.

1. Click ‘Get Form’ button to access the report form and open it for editing.
2. Enter the applicant's name in the designated fields, providing last, first, and middle names as required. Ensure that the information is accurate and complete.
3. Specify the sex of the applicant in the provided selection. Make sure to choose the most appropriate option.
4. Input the date of birth using the format requested in the form. Double-check for correctness.
5. Fill in the street address and apartment number in the corresponding fields. Include the city, state, and zip code to ensure precise identification.
6. If the mailing address differs from the above information, provide the details in the specified section. Repeat the city, state, and zip code entries.
7. In the signature field, sign your name in ink as it appears on your application. This must be done in the presence of the examining physician for identification.
8. Date the applicant's signature accordingly to maintain a chronological record.
9. For tuberculosis testing, provide the date of the test result and select the type of test conducted. Ensure to circle the correct option between Skin Test and X-Ray.
10. Record the result of the tuberculosis test, followed by the signature of the licensed medical provider. Include the provider's credentials and business address.
11. Repeat similar steps for the syphilis blood test section, detailing the date, type of test, and result in the appropriate fields.
12. Conclude by providing the licensed medical provider's signature, name, title, and business address once again, if different from the tuberculosis section.
13. Review the entire form for accuracy, save the changes, and choose to download, print, or share the completed document as needed.

Complete your HI Tuberculosis And Syphilis Report Form online today to ensure timely reporting and proper health management.