Virginia department of health tb risk assessment form tb512 2012-2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name, address, date of birth, and social security number in the designated fields. Ensure accuracy as this information is crucial for identification.
3. In Section I, check all applicable symptoms related to TB. If none apply, proceed to Section II. This section helps assess potential TB symptoms effectively.
4. For Section II, evaluate the risk factors for acquiring latent TB infection. Check all relevant boxes and provide additional details where necessary, such as the name of a source case if applicable.
5. Continue through Sections III and IV by checking any findings or actions that apply. This will guide healthcare providers on necessary follow-up actions based on the assessment.
6. Finally, ensure that all signatures are completed at the bottom of the form before saving or submitting your document.

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