Get Ga Dph Tb Unit 2016-2025

This guide provides detailed instructions on how to fill out the GA DPH TB Unit form online. It aims to assist users in completing the tuberculosis symptom screen effectively and accurately, ensuring that all necessary information is collected for proper assessment.

Follow the steps to complete the GA DPH TB Unit form accurately.

1. Press the ‘Get Form’ button to access the tuberculosis symptom screen form and open it for editing.
2. Begin by entering your name in the designated field. This should be your full legal name as it appears on official documents.
3. Indicate your sex by selecting either M or F. Ensure to circle the appropriate option.
4. Fill in your date of birth in the specified format (MM/DD/YYYY). This helps in confirming your age and eligibility.
5. Provide details regarding your last TB skin or blood test. Include the name, address, city, state, zip code, and phone number of the facility where the test was performed.
6. Record the date of the test and the results in millimeters, marking whether the result was Positive, Negative, or Indeterminate.
7. Respond to the treatment history questions by indicating if you have experienced chest x-ray abnormalities, latent TB infection treatment, or TB disease treatment.
8. If applicable, enter the number of months treated for latent TB infection or TB disease along with relevant details of when and where the treatment occurred.
9. Indicate whether you have ever received the BCG vaccine and provide the date if applicable.
10. Answer the questions regarding current symptoms experienced in the past few months, marking Yes or No for each listed symptom.
11. For each symptom that you answered Yes to, provide additional information such as duration or weight loss details.
12. State whether you know anyone experiencing similar symptoms and provide their name, address, and phone number if applicable.
13. Select the appropriate actions taken by checking all applicable options regarding your TB assessment.
14. Ensure you and the assessor sign the form in the designated signature fields to confirm accuracy and agreement.
15. Finally, save your changes and choose to download, print, or share the completed form as necessary.

Begin filling out the GA DPH TB Unit form online today to ensure timely and accurate assessment of tuberculosis symptoms.