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Get Health Screening Assessment Form 2013-2024

Sex: M F To assist with assessing the need for TB screening, please complete questions 1 9. If you would like to be screened for TB, please also complete questions 10 and 11, and notify your University Administrator (if a student) or Staff Health Nurse (if a health care worker) who will arrange testing. Please bring this form with you when you are tested. Yes No 2. Have you visited and/or lived in other countries for 3 months or more within the last 3 years? Please.

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