Tuberculosis immunization form 2026

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01. Edit your screening immunization form create online
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Click ‘Get Form’ to open the tuberculosis immunization form in the editor.
Begin by entering your personal information, including your name, date of birth (DOB), and Jag# in the designated fields.
Fill out the TB Skin Test (TST/PPD) and Quantiferon Gold sections by providing the test dates and results in millimeters. Indicate whether the result is positive, negative, normal, or abnormal.
If you have a positive TST result, ensure to provide the date of your chest X-ray in the specified field.
Complete the vaccination history section by listing all vaccines received, including measles (Rubeola), German measles (Rubella), mumps, MMR, and meningitis. Include the date administered for each vaccine.
If applicable, enter positive titer dates for Rubeola, Rubella, and Mumps in lieu of vaccination records.
Finally, ensure that a physician or authorized individual completes and signs the form. Include their license number or office stamp as required.

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