TB4 TB Risk Assessment Form - Cabinet for Health and 2026

1. Click ‘Get Form’ to open the TB4 TB Risk Assessment Form in the editor.
2. Begin by entering the patient's personal information, including name, date of birth, race, sex, and social security number. Ensure accuracy as this data is crucial for identification.
3. Fill in the address details along with contact numbers. If the patient is pregnant, indicate this and provide the last menstrual period (LMP) if applicable.
4. In Section I, screen for active TB symptoms by checking all relevant boxes. If none apply, proceed to Section II.
5. In Section II, assess risk factors for latent TB infection by checking applicable options. This includes evaluating exposure history and current health status.
6. Complete Sections III and IV by indicating any findings and actions taken based on the assessment results. Ensure all checks are made accurately.
7. Finally, sign and date the authorization section at the end of the form to confirm consent for testing.

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