Printable Blank Tb Skin Test Form Template Download PDF Ordering Information Tuberculin Skin Testing Fact Sheet Learn about the Mantoux tuberculin skin test TST TST administration TST interpretation and more for tuberculosis TB diagnosis Download PDF Alternative Languages Espa ol Spanish Last Reviewed February 14 2023
The skin test should be read between 48 and 72 hours after administration A patient who does not return within 72 hours will probably need to be rescheduled for another skin test Inspect site Visually inspect site under good light Erythema reddening of the skin do not measure Induration hard dense raised formation Palpate induration 1 Do you currently have any of the following symptoms Cough lasting more than 3 weeks unexplained Hemoptysis coughing up blood YES NO YES NO Fever or chills unexplained Night sweats sweating that leaves the bedclothes and sheets wet Persistent shortness of breath unexplained Chest pain unexplained Weight loss unexplained
Printable Blank Tb Skin Test Form Template
Printable Blank Tb Skin Test Form Template
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TUBERCULOSIS SKIN TEST TST SCREENING FORM Name Employee Medical Staff I agree to have 0 1 mL Mantoux tuberculin skin test TST administered intradermally under the skin in my forearm I understand that I must return in 48 72 hours to have each test read or I will need to have the test repeated The Tuberculosis Skin Test is a way of identifying TB infection You cannot get TB from the skin test RISKS POSSIBLE SIDE EFFECTS If you have been exposed to TB in the past swelling and redness may develop at the site of the test A blister or scar may also result The TB skin test should not be given to persons who have had a positive
RETURN TO Allegany College of Maryland Nurse Managed Wellness Clinic AH115 12401 Willowbrook Road SE Cumberland MD 21502 2596 FAX 301 784 5093 The employee must provide the results of the TST or Tuberculosis TB blood test and evaluation on the required Employee Tuberculin Skin Test TST and Evaluation CDCR 7336 form Definitions Induration Swelling or raised skin Note The presence of erythema is NOT indicative of a TST reaction only the induration is measured
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Skin test interpretation depends on two factors Measurement in millimeters of the induration Person s risk of TB infection or the risk of progression to TB disease if infected Classification of the Tuberculin Skin Test Reaction An induration of 5 or more millimeters is considered positive in People living with HIV Mycobacterium tuberculosis TB is a disease which is carried through the air in small particles when people who have active TB cough sneeze speak or sing It usually affects the lungs but can also affect the heart kidneys bones and other organs of the body The TUBERCULOSIS SKIN TEST is a way of identifying TB infection
TB Screening Form Please indicate if you have any of the following symptoms Yes Yes Yes No No No Chronic Cough Production of sputum If yes what color of sputum Blood streaked sputum Yes Yes Yes Yes No No No No Unexplained weight loss Unexplained fatigue tiredness Night sweats Fever The TUBERCULOSIS SKIN TEST TST is a way of identifying TB infection You cannot get TB from the skin test Health care workers are required to be screened regularly for TB Depending on where you work you may need to have annual TB skin test SIDE EFFECTS
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https://www.cdc.gov/tb/education/mantoux/default.htm
Download PDF Ordering Information Tuberculin Skin Testing Fact Sheet Learn about the Mantoux tuberculin skin test TST TST administration TST interpretation and more for tuberculosis TB diagnosis Download PDF Alternative Languages Espa ol Spanish Last Reviewed February 14 2023
https://www.cdc.gov/tb/education/mantoux/pdf/Mantoux_TB_Skin_Test.pdf
The skin test should be read between 48 and 72 hours after administration A patient who does not return within 72 hours will probably need to be rescheduled for another skin test Inspect site Visually inspect site under good light Erythema reddening of the skin do not measure Induration hard dense raised formation Palpate induration
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Printable Blank Tb Skin Test Form Template - The employee must provide the results of the TST or Tuberculosis TB blood test and evaluation on the required Employee Tuberculin Skin Test TST and Evaluation CDCR 7336 form Definitions Induration Swelling or raised skin Note The presence of erythema is NOT indicative of a TST reaction only the induration is measured
