Annual TB Questionnaire & sign and symptom Review This form is to be used with employees who have had a previous positive TB test and have already completed a medical evaluation where TB disease was.

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How to fill out the MI DHHS Tuberculosis Sign & Symptom Review online

Completing the MI DHHS Tuberculosis Sign & Symptom Review is an important step in managing your health, especially if you have had a previous positive tuberculosis test. This guide will walk you through each section of the form, providing clear instructions to ensure it is filled out accurately.

Follow the steps to complete the form effectively.

  1. Press the ‘Get Form’ button to access the MI DHHS Tuberculosis Sign & Symptom Review form and open it in a suitable format.
  2. Begin by filling out your personal details, such as first name, last name, and employee ID. Ensure that this information is accurate to avoid any confusion.
  3. Indicate the date of your previous positive TB test and select the type of test you underwent (IGRA or TST).
  4. Respond to the question about whether you have taken medications following your positive TB test. If you selected 'Yes,' specify if you completed the entire course of medications and provide the date treatment was completed.
  5. Provide the date of your last chest x-ray and include the results. This information is essential for evaluating your current health status.
  6. Answer the questions regarding any TB exposure or symptoms experienced in the past year. Please provide details, including the location and dates where applicable.
  7. Review the sign and symptom review section. For each symptom listed, indicate 'Yes' or 'No.' If you answer 'Yes' to any symptoms, please provide further details on the back of the form.
  8. Indicate whether a medical evaluation or chest x-ray is recommended and ensure the evaluator initials and date of evaluation are provided.
  9. Once you have completed all sections, review your responses for accuracy. You can then save your changes, download, print, or share the form as required.

Take the next step in your health management by completing the MI DHHS Tuberculosis Sign & Symptom Review online today.

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MI DHHS Tuberculosis Sign & Symptom Review Form

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