Search 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 skin wound.
%PDF-1.6 %âãÏÓ 127 0 obj > endobj 148 0 obj >/Filter/FlateDecode/ID[8C6B865DED1A994F8434B6F3009F603E>615D27A3718DCE45B1CD19FBC25D05F9>]/Index[127 34]/Info 126 0 R ...
Tuberculin Skin Test (TST) Record Form Patient Information Name: _____ Address: _____
The Tuberculosis Skin Test is a way of identifying TB infection. You cannot get TB from the skin test. RISKS & POSSIBLE SIDE EFFECTS: If you have been exposed to TB in the past, swelling and redness may develop at the site of the test. A blister or scar may also result.
All U.S. health care employees should have baseline TB screening, including an individual risk assessment which is necessary for interpreting any test result. For the risk assessment form see: https://www.cdc.gov/tb/topic/infectioncontrol/ pdf/healthCareSettings-assessment.pdf.
For previous POSITIVE Tuberculin Skin Test, complete the section at the bottom of page. Signature ___________________________________ (PPD readings must be 48 – 72 hours after administration.) TEST TWO: Given one to three weeks after Test One. Signature ___________________________________ (PPD readings must be 48 – 72 hours after administration.)
TUBERCULIN SKIN TEST FORM (also called TB or PPD) TO BE FILLED OUT BY THE STUDENT First Name Last Name Uniqname UM ID Phone Number TO BE FILLED OUT BY THE HEALTHCARE PROVIDER TUBERCULIN SKIN TEST Date Administered Date Read Results (circle one)*: Positive Negative
