Tuberculosis screening questionnaire
[DOC File]TB4 TB Risk Assessment Form - Ky CHFS
https://info.5y1.org/tuberculosis-screening-questionnaire_1_264f7d.html
Screening for persons with a history of LTBI should be individualized. Assess Risk for Acquiring LTBI. The Patient: ___ is a current high risk contact of a person known or suspected to have. TB disease. ___ has been in another country for - 3 or more months where TB is. common, and has been in …
[DOC File]ANNUAL TUBERCULOSIS SCREENING QUESTIONNAIRE
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Title: ANNUAL TUBERCULOSIS SCREENING QUESTIONNAIRE Author: user100 Last modified by: user151 Created Date: 9/23/2015 7:52:00 PM Company: IHS Other titles
[DOCX File]Facility Tuberculosis (TB) Risk Assessment Worksheet for ...
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Jun 24, 2020 · Facility Tuberculosis (TB) Risk Assessment Worksheet for Health Care Settings Licensed by MDH* Updated 6/24/2020. Background. Health care settings licensed by MDH (boarding care homes, home care providers, hospices, nursing homes, outpatient surgical centers, and supervised living facilities) may use either of the following options to meet the “perform a TB facility risk …
[DOC File]www.acha.org
https://info.5y1.org/tuberculosis-screening-questionnaire_1_554183.html
Part I: Tuberculosis (TB) Screening Questionnaire (to be completed by incoming students) Please answer the following questions: Have you ever had close contact with persons known or suspected to have active TB disease? ( Yes ( No Were you born in one of the countries or territories listed below that have a high incidence of active TB disease ...
[DOCX File]Clayton State University - Home
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Part I: Tuberculosis (TB) Screening Questionnaire (to be completed by incoming students) Please answer the following questions: (If . you answer yes to the first question, please CIRCLE the country below) Afghanistan. Algeria. Angola. Argentina. Armenia. Azerbaijan. Bahrain. Bangladesh. Belarus. Belize. …
[DOCX File]Communicable Disease / Tuberculosis Screening ...
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DEPARTMENT OF HEALTH SERVICES. Division of Quality Assurance. F-01679 (12/2015) STATE OF WISCONSIN. Wis. Admin. Code § DHS 105.17(1r)(a-b) COMMUNICABLE DISEASE / TUBERCULOSIS SCREENING QUESTIONNAIRE. The Department requires that health care agencies or providers screen all health care staff WITHIN 90 DAYS BEFORE DIRECT CONTACT AND PERIODICALLY, to ensure …
[DOC File]TB Screening Tool for Healthcare Workers
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Serial TB screening includes three components: (1) Assessing for current symptoms of active TB disease * and* (2) Assessing HCW’s history *and* (3) Testing for the presence of infection with Mycobacterium tuberculosis by administering either a single TB blood test or a single TST. Symptoms of active TB disease (circle all that are present)
[DOC File]sites.sju.edu
https://info.5y1.org/tuberculosis-screening-questionnaire_1_5aa120.html
Tuberculosis (TB) Screening Questionnaire ... ( Recently infected with M. tuberculosis (within the past 2 years) ( History of untreated or inadequately treated TB disease, including persons with fibrotic changes on chest radiograph consistent with prior TB disease
[DOCX File]Texas Health Steps TB Questionnaire
https://info.5y1.org/tuberculosis-screening-questionnaire_1_94ccff.html
Questions About Your Child and Tuberculosis (TB) Child’s NameDate of Birth Your Name Today’s Date . We need your help to find out if your child has been exposed to the disease tuberculosis, also known as TB. TB is caused by germs. It is usually spread to another person by coughing or sneezing.
[DOC File]TUBERCULOSIS RISK ASSESSMENT WORKSHEE
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2. Screening of HCWs (health care workers) for TB infection. a. Does this health-care setting have a TB screening program for Yes ___ No ___ HCWs? If yes, which HCWs are included in the TB screening program? __ Physicians __ Engineering staff __ Mid-level practitioners (nurse practitioners and PAs)
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