CONSENT FOR TUBERCULIN SKIN TEST 2025

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4.9 out of 5

50 votes

The document is a consent form for a Tuberculin Skin Test (Mantoux Test) that collects personal information from the patient, including medical history related to tuberculosis and immunizations. It outlines the procedure for the test, including the need to return for reading the results, and requires the patient's signature to acknowledge understanding of privacy practices.

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Click ‘Get Form’ to open the CONSENT FOR TUBERCULIN SKIN TEST in our editor.
Begin by filling in your Last Name, First Name, and Middle Initial (M.I.) in the designated fields. Ensure accuracy for proper identification.
Enter your Address, City, State, and Zip Code. This information is crucial for contact purposes.
Provide your Phone number and Date of Birth. This helps the health department manage records effectively.
Indicate the Reason the test is needed and answer the questions regarding previous TB skin tests and immunizations by selecting 'Yes' or 'No'.
If applicable, women should confirm pregnancy status and discuss it with their doctor before proceeding.
Acknowledge your appointment details for returning to have the test read by signing at the bottom of the form.
Finally, complete the RECORD OF MANTOUX TEST section with relevant dates and results after your test has been administered.

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

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Got questions?

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 pharmacists read TB tests?

Administering and reading TB skin tests requires training, supplies, and short amount of time, all of which the pharmacist can perform and incorporate into daily workflows.

Can you get a TB test read anywhere?

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.

Who can read the TB test?

A trained health care provider reads a TB skin test between 48 and 72 hours after placement.

Who can legally read a TB 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.