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Get Tn Mh-5426 2015-2025
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How to fill out the TN MH-5426 online
The TN MH-5426 is a crucial document used for screening tuberculosis symptoms. This guide will provide you with step-by-step instructions to ensure that you complete the form correctly and thoroughly.
Follow the steps to complete the TN MH-5426 form online.
- Click the ‘Get Form’ button to obtain the form and open it in your preferred online editor.
- In the 'Name' field, enter the individual’s last name, first name, and middle initial. Fill in the date of birth (DOB) in the specified format (MM/DD/YYYY).
- Complete the 'Facility' section by entering the name of the facility where the screening is conducted. Fill in the 'Contact Person' with the name of the individual responsible for the screening.
- Provide the address of the facility in the designated area. Ensure to also input the phone number and fax number of the facility as required.
- In the 'Program type' section, select one of the options: Residential, Non-residential, or Personnel by checking the appropriate box.
- For Section I: Signs and Symptoms of TB Disease, check 'Yes' or 'No' next to each symptom listed based on the individual's current condition.
- In Section II: Evaluation for TB Infection (TBI), indicate if there is a documented history of a previous positive TB test. If applicable, attach a copy of the test results. Similarly, indicate if there is a documented history of a previous negative TB test within the last 12 months and attach results if available.
- Proceed to Section III: Disposition. Based on the responses to the previous sections, follow the decision-making steps to determine if action is needed, and check the appropriate boxes.
- Finally, after completing all sections, ensure to include the interviewer's signature, title, and the date at the bottom of the form.
- After you have filled in all the necessary information, you can save any changes, download the completed form, print it, or share it as required.
Complete the TN MH-5426 form online today to ensure timely and accurate tuberculosis screening.
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In Tennessee, you can request a religious exemption for vaccines by submitting a written statement expressing your beliefs. This statement must be provided to your school or institution. Additionally, US Legal Forms can assist you in preparing a formal request, ensuring that you comply with state requirements while submitting your exemption for the TN MH-5426.
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