Get Mandatory Tuberculosis Screening Form For Fourth Year (m4) Fau Medical Students 2015-2025

Completing the Mandatory Tuberculosis Screening Form is an essential step for Fourth Year FAU Medical Students. This guide will provide you with clear instructions to successfully fill out the form online, ensuring compliance with health requirements.

Follow the steps to complete your form effectively.

1. Click ‘Get Form’ button to access the form and open it in the designated editor.
2. Fill in your personal information, including your last name, first name, middle initial, student Z number, date of birth, gender, permanent street address, city, state, zip code, and telephone number.
3. Under the REQUIRED SCREENING section, provide documentation of a single tuberculin skin test (PPD) performed within the last 6 months. Indicate the date of the test and whether it was positive or negative.
4. If you had a positive PPD, complete the Tuberculosis Screening Questionnaire and attach your chest x-ray report if applicable. Specify the date of your most recent chest x-ray.
5. Sign the form confirming that the information provided is accurate. Enter the date and include the physician's printed name and signature where required.
6. If needed, also fill out the Tuberculosis Screening Questionnaire, including additional personal information and any relevant symptoms. Ensure you have the healthcare provider's certification and official stamp.
7. Once all sections are completed, review your entries for accuracy. Save changes, then download or print the form for submission.
8. Return the completed form to the FAU Immunization Office, ensuring you meet the specified deadline.

Complete your Mandatory Tuberculosis Screening Form online today to ensure you meet the health requirements for your medical studies.