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Tuberculosis Surveillance Summary Record

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$29.95
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SKU: 2121P
$29.95

Updated November 2022
Briggs Tuberculosis Surveillance Summary Record is used to record and track TB surveillance for residents and facility employees.
The form Includes a baseline assessment for increased risk of TB as well as:

Prior testing history
Initial skin (Mantoux) or blood (IGRA) testing and results
Recording:
§ X-rays
§ Previous TB treatment
§ Bacteriology
§ Reporting to Health Department
§ Chemotherapy for infection or disease Voluntary HIV testing
Also includes fields to record skin and blood tests, x-ray screening, and bacteriology testing
Additional space provided to record supplementary clinical information and comments

Download a sample today!

·        Size:  8 1/2" x 11"

·        Paper:  White 

·        Print:  2-sides; Black Ink

·        Hole Punch:  5-Holes Top & Side

·        Packaging:  100 per pad

 

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