Free Tb Test PDF Form Get Document

Free Tb Test PDF Form

The Tuberculosis Skin Test Form is a crucial document used to record the details of a tuberculosis skin test, ensuring accurate tracking of patient information and test results. It includes essential fields such as the healthcare professional's name, testing location, and the results of the test. To ensure the validity of this document, all sections must be completed.

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Outline

The Tuberculosis (TB) Skin Test Form is a crucial document used in healthcare settings to track and record the administration and results of the TB skin test, commonly known as the PPD (Purified Protein Derivative) test. This form captures essential information, including the names of both the healthcare professional and the patient, as well as the testing location and the date the test was placed. It specifies the site of the test, whether on the right or left arm, and includes details such as the lot number and expiration date of the testing material. The form must be signed by the administering healthcare professional—be it a registered nurse (RN), medical doctor (MD), or another qualified individual—ensuring accountability and proper documentation. After the test is placed, it is critical to read the results within 48 to 72 hours, which is also noted on the form. The induration, or swelling, is measured in millimeters and recorded, indicating the test's reaction. Finally, the results are reported as either negative or positive, with another signature required to confirm that the results have been accurately read and documented. To ensure the form's validity, it is imperative that all sections are completed thoroughly.

Key takeaways

When filling out the TB Test form, keep the following key points in mind:

  • Ensure to include the Healthcare Professional/Patient Name at the top of the form.
  • Clearly specify the Testing Location where the test is administered.
  • Record the Date Placed accurately; this is crucial for tracking.
  • Indicate the Site of the test, whether it is the right or left arm.
  • Fill in the Lot # and Expiration Date for the PPD used.
  • The form must be signed by the person who administered the test, which can be an RN, MD, or another qualified professional.
  • Results must be read and recorded within 48-72 hours from the date placed.
  • All sections of the form must be completed for it to be valid.

Form Preview Example

 

 

 

 

 

TUBERCULOSISSKINTESTFORM

Healthcare Professional/Patient Name:

Testing Location:

 

 

 

 

 

 

 

 

 

 

 

Date Placed:

 

 

 

 

 

 

 

 

 

 

 

 

Site:

Right

Left

 

 

 

 

 

 

 

 

Lot #:

 

 

 

 

 

Expiration Date:

 

 

Signature (administered by):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

RN

 

MD Other:

 

 

 

Date Read (within 48-72 hours from date placed):

 

 

 

 

 

 

Induration (please note in mm):

 

mm

PPD (Mantoux) Test Result:

 

 

 

Negative

Positive

Signature (results read/reported by):

RN

MD Other:

*In order for this document to be valid/acceptable, all sections of this form must be completed.