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TB Questionnaire - Sutter Health 2026
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- Click ‘Get Form’ to open the TB Questionnaire in our editor.
- Begin by selecting whether you are a New Hire, Annual, or Post Exposure by checking the appropriate box.
- Fill in your personal details including your name, job title, date of birth, workplace site, department, and employee ID number in the designated fields.
- Answer the questions regarding your TB history by checking 'Yes' or 'No' for each item. Provide additional details if necessary in the text fields provided.
- If applicable, indicate whether you prefer to discuss any 'Yes' answers with an Employee Health physician.
- Sign and date the form at the bottom to acknowledge that your lab test results will be part of your medical record.
- Once completed, save your document and return it via email or fax to your Employee Health Division as instructed.
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What does TB screening involve?
For a TB test in blood (also called an IGRA test), a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out.
What questions to ask when screening for TB?
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 questions do they ask for TB screening?
Complete your TB risk assessment online through the myUOHealth portal.
What not to do before a TB test?
In general, theres nothing you have to do before this test, unless your healthcare provider asks you to.
What are TB questions?
Tuberculosis (TB) is caused by a bacterium called Mycobacterium tuberculosis (M. tuberculosis). The bacteria, or germs, usually affect the lungs. TB germs can affect any part of the body, such as the kidneys, spine, or brain.
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People also ask
Can I do a TB risk assessment online?
The purpose of the TB risk assessment and screening form is to identify persons with increased risk for TB who may require further testing and evaluation. Persons born in countries where TB is common are at increased risk for TB (especially, but not limited to those who arrived in the last 5 years).
Related links
TB disease, an individual showing a positive TB test requires further screening with other diagnostic procedures. If the member does not return to have his
All new incoming UCI students must complete a TB Screen Risk Form. This form can be found in My Student Chart under Medical Clearances.
Aug 13, 2024 Sign up to receive an email about TB prevention and Risk Assessment updates on the CDPH TB Control Branch webpage.