Get Sentara Life Care Assisted Living Facility Report Of Tuberculosis Screening Evaluation
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How to fill out the Sentara Life Care Assisted Living Facility Report of Tuberculosis Screening Evaluation online
Completing the Sentara Life Care Assisted Living Facility Report of Tuberculosis Screening Evaluation is a crucial step in ensuring the health and safety of residents. This guide provides clear instructions on how to fill out the form online, making the process straightforward and efficient.
Follow the steps to complete the evaluation form online.
- Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
- Begin by entering the resident's last name, first name, and middle or maiden name, if applicable. Provide the complete address, including city, state, and zip code.
- Indicate the date of the most recent Mantoux tuberculin skin test. If the individual has a previously positive test or if any of the above information is unknown, check the appropriate box.
- Input the date of birth of the individual being evaluated. Include the measurement of induration in millimeters from the skin test results.
- If the individual is exhibiting TB-like symptoms, check the designated box.
- If the TB skin test result is 10 mm or greater (or 5 mm in the case of HIV infected individuals) or if there are TB-like symptoms, fill in the date of the last chest x-ray evaluation and determine if the chest x-ray suggests active TB by selecting 'Yes' or 'No'.
- Indicate whether sputum smears were collected and analyzed for the presence of Acid Fast Bacilli (AFB). Select 'Yes' or 'No' for this section.
- If 'Yes' was selected for the previous question, confirm whether three consecutive smears were negative for AFB by indicating 'Yes' or 'No'.
- Based on the collected information, state whether the individual is free of communicable TB by selecting 'Yes' or 'No'.
- Lastly, enter the name of the licensed physician, physician's designee, or local health department official completing the evaluation. Provide the printed name, signature, phone number, and the date the evaluation was completed.
- Review all the entered information for accuracy. Once finalized, save the changes made to the document. You can also choose to download, print, or share the completed form as needed.
Complete the Sentara Life Care Assisted Living Facility Report of Tuberculosis Screening Evaluation online for a streamlined process.
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A tuberculosis evaluation is a systematic approach to confirm or rule out the presence of TB in an individual. This includes reviewing medical history, conducting physical examinations, and performing skin or blood tests. The Sentara Life Care Assisted Living Facility places high importance on these evaluations to ensure the well-being of both residents and staff.
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