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Tb skin test consent form

Consent For TB Test - City of Massillon, Ohio 2025

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The document is a consent form for a Tuberculin Skin Test (Mantoux Test) that collects personal information from the patient, including their medical history related to tuberculosis. It includes questions about previous TB tests, immunizations, and pregnancy status. The patient acknowledges understanding the procedure and agrees to return for the test reading, while also confirming receipt of privacy practices from the health department.

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Click ‘Get Form’ to open the Consent For TB Test in our editor.
Begin by entering your last name, first name, and middle initial in the designated fields at the top of the form.
Fill in your address, date of birth, city, state, and zip code accurately to ensure proper identification.
Provide your phone number for any necessary follow-up communications.
Answer the questions regarding previous TB skin tests and immunizations by selecting 'Yes' or 'No' as applicable.
If you are a woman and pregnant, indicate whether you have discussed the TB test with your doctor by selecting the appropriate option.
In the section for the reason the test is needed, provide a brief explanation if required.
Sign and date the form at the bottom to acknowledge consent and understanding of privacy practices.
Complete the Record of Mantoux Test section after your test is administered, including dates and results as instructed.

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Versions	Form popularity	Fillable & printable
2017	4.9 Satisfied (50 Votes)
2010	4 Satisfied (24 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can any doctor do a TB test?

You can get tested for TB at the health department or at your health care providers office. Your health care provider will choose the TB test that is best for you. Public and private health care plans may cover TB testing costs.

Can a medical assistant read a TB test in Ohio?

The interpretation of a TB skin test result can only be done by an Advanced Registered Nurse Practitioner (ARNP), a Physician Assistant (PA), or a Medical Doctor (MD).

Who can administer a tuberculin skin test?

Who can administer and read TB skin tests? The TB skin test should be placed (administered) and read by a designated, trained health care provider. Consult with your state and local public health authorities to determine who is authorized to place and read TB skin tests in your state.

What are the CDC guidelines for TB testing?

Key points CDC recommends testing people who are at increased risk for TB infection. People with symptoms of TB disease or positive TB blood test or TB skin results should be evaluated for TB disease. TB testing activities should be accompanied by a plan for medical evaluation and treatment.

Can I get a TB test without a doctor ordering it?

Further testing may be required if the blood test is positive. No doctors visit needed. Buy this TB blood test, visit a nearby Quest location, and get fast results.

Can a nurse administer a TB skin test?

It may be within the scope of practice of the competent and appropriately trained registered nurse to administer and read the tuberculosis (TB) skin test under the direction of an authorized health care practitioner.

Consent For TB Test - City of Massillon, Ohio 2025

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