Tuberculosis Surveillance Summary Record
Document Tuberculosis (TB) surveillance for residents as well as employees.
Includes Baseline Assessment for Increased Risk of TB.
This form provides a record for dates and results of ongoing periodic TB tests with space for documenting the type of test, result, recommended treatment and date of report to the Health Department (if required).
Also includes fields to record periodic x-ray screening, bacteriology testing and HIV testing.
· Size: 8 1/2" x 11"
· Paper: White
· Print: 2-sides; Black Ink
· Hole Punch: 5-Holes Top & Side
· Packaging: 100 per pad