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Get VA TB 512 2016

Ate Given or Drawn Time Signature IGRA (Check One) Site_ POS#_ TST READING/ IGRA Results Date Read Time Signature POS# mm Induration Neg (TST or IGRA) Pos Borderline/Indeterminate – IGRA ONLY #2 TST Lot#_ Date Given or Drawn Signature or Time IGRA (Check One) Site_ POS#_ TST READING/ IGRA Results Date Read Time Signature POS# Induration mm Pos Neg (TST or IGRA) Borderline/Indeterminate – IGRA ONLY Screener’s signature: _ Screener’s name(print): Date: Phone #: I hereby au.

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