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TB Questionnaire - Sutter Health

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The document is a confidential Tuberculosis (TB) Screening Questionnaire intended for employees to complete and return to the Employee Health Division. It includes sections for personal information, TB history, symptoms, and exposure risks. Employees are required to answer specific questions regarding their TB status and health history, with instructions for submitting the form and details about lab testing locations.

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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.

How do I get proof of TB test?

Ask your health care provider for a written record of your positive TB test result. This will be helpful if you are asked to have another TB test in the future.

What questions do they ask for TB screening?

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?

What are the 4 symptom screening for TB?

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).

What are the 4 TB screening questions?

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.

What does a TB assessment consist of?

A TB test checks to see if youve been infected with tuberculosis (TB). There are two types of TB tests: a skin test and a blood test. TB skin and blood tests can show if youve ever been exposed to the bacterium that causes TB, but they cant determine if you have a latent (dormant) or active TB infection.

What is the 4S complex for TB?

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.

What are the 4 pillars of TB elimination?

NSP 20172025 has four pillars: Detect, Treat, Prevent, and Build. These pillars emphasise the importance of early and accurate diagnosis of TB; treatment of TB; control and spread of TB infection; and focus on community participation.

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