Navmed 6224 8-2026

The document is a Tuberculosis Exposure Risk Assessment form designed for patients, including those with previous positive tuberculin skin tests. It includes a series of questions to evaluate potential exposure to tuberculosis, recent travel history, and symptoms such as chronic cough. Based on the responses, it determines the need for further medical evaluation or testing for latent tuberculosis infection (LTBI). The form also includes sections for provider comments and patient identification.

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Click ‘Get Form’ to open the navmed 6224 8 document in the editor.
Begin by answering question 1 regarding exposure to individuals known or suspected of having active tuberculosis. Select 'Yes', 'No', or 'Don't Know' as appropriate.
Proceed to question 2, where you will indicate if you had direct contact with specific groups. Again, choose from 'Yes', 'No', or 'Don't Know'.
In question 3a, check any countries you have traveled to since your last assessment. If applicable, provide additional country names in the 'Other' section.
For questions 3b and 3c, answer whether you traveled to Afghanistan and if you had prolonged contact with the local population.
Continue through questions about chronic cough and other symptoms in section 4, ensuring all relevant fields are completed accurately.
Finally, review your answers before submitting the form for further evaluation by a medical officer if necessary.

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