The Tuberculosis Skin Test Form is a crucial document used to record the administration and results of the tuberculosis (TB) skin test, also known as the PPD test. This form captures essential information such as the healthcare professional's name, testing location, and the test results, ensuring accurate monitoring of TB exposure. Proper completion of all sections is vital for the form's validity and acceptance.
The Tuberculosis (TB) Skin Test Form is an essential document used to record important information regarding TB testing. This form captures key details such as the healthcare professional's name, the patient's name, and the specific testing location. It also includes critical dates, such as when the test was placed and when it should be read, typically within 48 to 72 hours. The form requires the healthcare provider to indicate which arm was used for the test and to note the lot number and expiration date of the test material. Additionally, the form must be signed by the administering professional, whether they are a registered nurse, medical doctor, or another qualified individual. After the test is read, the results—either negative or positive—must be documented along with the signature of the person who interpreted the results. It’s important to remember that for the TB Skin Test Form to be valid and acceptable, every section must be completed thoroughly. This ensures accurate tracking and reporting of TB testing, which is crucial for public health and individual care.
TUBERCULOSISSKINTESTFORM
Healthcare Professional/Patient Name:
Testing Location:
Date Placed:
Site:
Right
Left
Lot #:
Expiration Date:
Signature (administered by):
RN
MD Other:
Date Read (within 48-72 hours from date placed):
Induration (please note in mm):
mm
PPD (Mantoux) Test Result:
Negative
Positive
Signature (results read/reported by):
*In order for this document to be valid/acceptable, all sections of this form must be completed.
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When filling out the Tuberculosis (TB) Test form, it is essential to follow specific guidelines to ensure accuracy and compliance. Here are key takeaways to consider: