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  1. 15 Δεκ 2023 · This model worksheet should be considered for use in performing tuberculosis (TB) risk assessments for health care facilities and nontraditional facility-based settings. Facilities with more than one type of setting will need to apply this table to each setting.

  2. This model worksheet should be considered for use in performing TB risk assessments for health-care facilities and nontraditional facility-based settings. Facilities with more than one type of setting will need to apply this table to each setting. 1. Incidence of TB.

  3. The register review assesses the number and type of TB services that were provided to people with TB during a specified period of time and TB-related patient outcomes. It includes a review of the relevant TB registers at sampled health facilities (i.e., TB laboratory registers, TB treatment registers, DR-TB treatment

  4. Healthcare Personnel (HCP) Annual Symptom TB Screening Last, first and middle initial Date of birth 1) Do you currently have any of the following symptoms?

  5. *Once a person has a documented positive test for TB infection that has been followed by an x‐ray that was deemed free of infectious TB, the TB risk assessment is no longer required. 1 Adapted from a form developed by Minnesota Department of Health TB Prevention and Control Program and Centers for Disease Control and Prevention.

  6. TUBERCULOSIS SCREENING QUESTIONNAIRE FORM. SECTION 1: INFORMATION/CONSENT . Mycobacterium tuberculosis (TB) is a disease which is carried through the air in small particles when people, who have active TB cough, sneeze, speak, or sing. It usually affects the lungs but can also affect the heart, kidneys, bones, and other organs of the body.

  7. Guidelines: Diagnosis of tuberculosis in adults and children. Clin Infec Dis 2017;64:111–5). Adapted from: Risk assessment form developed by the California Department of Health, Tuberculosis Control Branch. Sosa LE, Njie GJ, Lobato MN, et al. Tuberculosis Screening, Testing, and Treatment of U.S.

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