Tuberculosis Surveillance Summary Record – DIGITAL FORM
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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!
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
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Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.
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*SUBSCRIPTION: Form access is licensed for 1-year per agency/facility location. Multiple sites require a quote. This digital form is delivered as a form-fillable PDF and includes 1-year of updates. To receive your electronic file and updates you must complete and return a content license agreement and provide an end-user email address and contact name for file delivery (please allow 2-3 business days for order fulfillment) and provide the facility/agency address. After 1- year, your subscription will automatically renew.
All Briggs Digital on Demand products require a credit card payment (or pre-payment) to receive digital files electronically.
Briggs Healthcare does not allow use of any of its intellectual property without a valid license and payment of fees.