Tuberculosis (TB) Symptom Screen 2026

1. Click ‘Get Form’ to open the Tuberculosis (TB) Symptom Screen in the editor.
2. Begin by entering your name and selecting your gender. Fill in your date of birth for accurate identification.
3. Provide details about your last skin test, including the name, address, city, state, zip code, and phone number of the testing location.
4. Indicate the test date and results by filling in the measurement in mm. Select whether the result was positive or negative.
5. Complete the chest X-ray section by marking if it was normal or abnormal.
6. Answer questions regarding previous treatments for latent TB infection or TB disease, including duration and medication names if applicable.
7. Respond to symptom-related questions such as cough duration, mucus color, night sweats, fevers, fatigue, chest pain, shortness of breath, weight loss, and coughing up blood.
8. Fill in any additional information about known contacts with similar symptoms and check all applicable actions taken at the end of the form.
9. Finally, sign the assessment section along with the client’s signature before saving or sharing your completed form.

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