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Appendix C 11 - Sample FGP-SCP TB Test Form: Fill out & sign online 2026

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The document is a sample TB Test Form for the ABC Foster Grandparent/Senior Companion Program, outlining the requirements for tuberculosis testing for volunteers. It includes sections for personal information, test results, and provider details. Additionally, it provides a separate screening form for volunteers with a history of positive TB tests, detailing follow-up questions and necessary health professional signatures.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your personal information in the designated fields, including your name, date of birth, address, and phone number.
If you have had a positive TB test previously, skip the TB test section and proceed to the next page. Otherwise, fill in the PPD test date and the date read.
Indicate the number of millimeters of induration and provide results/interpretation as required.
Complete the provider information section by adding the health professional's signature, hospital/clinic/organization name, and date.
If applicable, fill out the Positive Tuberculosis (TB) Test Screening Form with details regarding past positive tests and any follow-up treatments or symptoms.

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