Annual screening questionnaire form 2025

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Tuberculosis Risk Assessment Have you had a cough lasting more than three weeks? Have you lived with or spent time with anyone who had or may have had TB? Have you lived in or visited any of the following areas for more than a month: Africa, Asia, Mexico, Central or South America, the Caribbean or Eastern Europe?
At ART centers, all PLHIV are screened for TB at every visit, using the 4-symptom (4S) complex which includes cough of any duration, fever, weight loss, and night sweats among adults. In children, the 4S complex includes current cough, fever, poor weight gain, and history of contact with a TB case.
The purpose of the survey is to provide health professionals with a comprehensive understanding of an individuals current health condition, which can help in providing appropriate recommendations for their well-being.
Please answer the following questions: Have you ever had a positive TB skin test? Have you ever had close contact with anyone who was sick with TB? Have you ever been vaccinated with BCG? * The significance of the travel exposure should be discussed with a health care provider and evaluated.
Screening questions need to be short and easy for respondents to answer. They should avoid binary response options but also should not include too many response options. You should order the response options in the right way, and the overall screener shouldnt contain too many questions.
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The World Health Organization (WHO) recommends that PLHIV, including pregnant women, should be routinely screened for symptoms of active TB at every health facility visit using a four‐symptom screen (cough, fever, night sweats, and weight loss (WHO 2011a).

tb annual screening questionnaire form