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2 Step Tb Skin Test Form: What You Should Know
Last name(s) are optional but should be included. The second item you will need is: Your mailing address. If no place is given, please indicate: City name (if known). State Name (if known). County (if known) Please use only the last 4 characters of your mailing address and not the street address. Your name and birthdate(s). (optional) You should not include a “TUBERCULIN TEST”, as this is a violation of HIPAA and is invalid. Your first two-step skin test kit(s), as well as the following items: the initial two-step TBT test kit, one or two contact gauges if required by your employer or school or A non-sterile sterile saline dipstick, measuring one fluid ounce of blood per drop and one of serum (spleen) one fluid ounce per drop. (optional) You should not include a “TUBERCULIN TEST”, as this is a violation of HIPAA and is invalid. The following items are included below just for documentation purposes: Tb Skin Treatment Kit for Two-Step Skin Test: Tb Skin Treatment Kit for Two-Step Skin Test. (optional) Please use only the last 4 characters of your mailing address and not the street address. Please include your doctor's name and address, your telephone number and cell phone number (optional). Treatment Record (optional): Two-Step Tb Skin Test Record For previous TUBERCULIN SKIN TEST, complete page at bottom. TUBERCULIN SKIN TEST FORM For previous POSITIVE TUBERCULIN SKIN TEST, complete the section at the bottom of page. TUBERCULIN TEST KIT AND CONDITIONAL TEST FORM. Fill in first section only. First Section — First Contact Gauge: Test results with contact-gauge results will be sent to one person at the hospital, depending on the location.
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