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Results. * It is very unlikely that a side effect to the test will occur. If such an event does happen, the most common reaction is pain or redness at the test site. In very rare cases, a person who is hypersensitive to the solution could have a severe allergic reaction near the injection site. Such rare reactions may include blistering or a ...
Find professionally drafted PPD forms and templates. Simplify the process of Tuberculosis risk assessment with our customizable PPD form.
2-Step Mantoux Skin Test. Step 1: Do an initial tuberculin skin test (Mantoux, 5 TU PPD). Read results 48-72 hours later. Step 2: If the results from Step 1 is 0-9mm of induration: Do a second tuberculin skin test in the other arm 7 to 21 days after Step 1.
TUBERCULOSIS/MANTOUX SKIN TESTING FORM . SECTION I: INFORMATION/CONSENT . Mycobacterium tuberculosis (TB) is a disease which is carried through the air in small particles when people who have active TB cough, sneeze, speak, or sing.
To determine if a skin test should be administered, conduct a risk assessment for each patient that takes into consideration recent exposure to TB disease, clinical conditions that increase the risk for TB disease if infected, and the program’s capacity to deliver treatment for latent TB infection. Locate and clean injection site.
TUBERCULIN SKIN TEST FORM (also called TB or PPD) TO BE FILLED OUT BY THE STUDENT. TO BE FILLED OUT BY THE HEALTHCARE PROVIDER. *Please note that a positive result requires a chest x-ray.
TEST TWO: Given one to three weeks after Test One. Manufacturer & Lot number _____Manuf. Exp. Date _____ Date vial opened _____ Date & time test ... TB Screening Form – Please indicate if you have any of the following symptoms: Yes No Chronic Cough Yes No Unexplained weight loss Yes No Production of sputum Yes No Unexplained fatigue/tiredness ...
