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Free printable Tb Test Form: What You Should Know
TB test. I am not pregnant. I have not had a PPD skin test before. Furthermore, I am under the care of a physician who will be administering my PPD tuberculin skin test. Furthermore, I am a U.S. Citizen who is at least 18 years old. Furthermore, I will sign this form. Furthermore, I understand that I will have this test to determine my susceptibility to tuberculosis (the bacteria that causes TB). Furthermore, I understand that the purpose of this test is to help detect whether I have the tuberculosis bacteria in my body and to determine if I am susceptible to developing tuberculosis. Furthermore, I understand that the results from this test will be reported to a provider who may or may not provide treatment of TB or prescribe a course of the tuberculosis medication Ticarcillin or another drug that may be required for my treatment. Furthermore, I understand that after completion of this test I may be required to take a PPD skin test for the next 4 hours. Furthermore, I understand that the PPD result from this test may be used to deny me medical treatment before the tuberculosis diagnosis or to place me on the watch list for treatment. Furthermore, I understand that the PPD result from this test will be disclosed to my health care provider who may have the right and responsibility for providing treatment of my tuberculosis disease. Furthermore, I agree that I will follow any instructions from my health care provider relating to tuberculosis or may contact my health care provider directly to discuss my medical condition and health concerns or questions. I agree that my information will not be shared with anyone without my permission; and I will retain and notify a provider, if I am contacted by a health care provider or health care provider's representative about TB or any concerns related to this test or to my tuberculosis disease. Furthermore, I understand that if you are testing for TB yourself but do not have a provider who will be providing medical care for me, you should not sign up to receive your tuberculosis test. Instead, you should contact your state's TB-related care coordination agency. You may request information about PPD testing and the PPD skin test by contacting the nearest TB-related care coordination agency. You may also contact this service during regular business hours. You may access information about PPD testing and the PPD skin test by using this form. My signature will help verify that I agree to have a PPD skin test. Online TB Tester Services Online TB Tester. It's free and you make it. TBT ester.
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