Get Ky Tb-4 2018-2026

The KY TB-4 form is essential for assessing tuberculosis (TB) risk in patients. This guide will provide you with clear and concise instructions on how to complete the form online, ensuring that all necessary information is accurately documented.

Follow the steps to successfully complete the KY TB-4 form.

1. Click the ‘Get Form’ button to retrieve the form and open it in your digital workspace.
2. Begin by entering the patient’s full name in the designated field, specifying their date of birth, race, sex, and Social Security Number.
3. Fill in the address section with the patient's complete residential address, including city, state, and zip code.
4. Input the patient's home and work phone numbers, as well as their cell phone number. Indicate if the patient is pregnant and provide the last menstrual period if applicable.
5. Record the patient's preferred language, country of origin, year they arrived in the US, and whether an interpreter is needed.
6. List any known allergies and current medications in their respective fields.
7. In Section I, check all active TB symptoms that apply. If none apply, move to Section II.
8. In Section II, screen for TB infection risk by checking all applicable high-risk factors related to TB exposure and infection.
9. Review Section III to check any findings that apply regarding the patient’s history and risk factors.
10. Complete Section IV by noting any actions taken, including issuing screening letters or referring for further evaluation.
11. Ensure that the screener’s signature, printed name, title, date, and contact number are filled in at the end of the form.
12. Review all entered information for accuracy, then save your changes, download, print, or share the completed form as needed.

Complete your documentation efficiently by filling out the KY TB-4 form online.