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Tuberculosis Skin Test Reporting

* = Required

Health Care Provider Demographics

Patient Demographics


* Date of Birth

Tuberculin Skin Testing

* Reason for testing


  , etc.)



* Date Administered

* Date Read

(record in mm induration)

* Interpretation  

+ Add more Results


Chest X-ray Results  

Healthcare Provider, Consider the Following for Follow-up

Referred to Respirologist  

Patient Informed of Signs and Symptoms  

Chemoprophylaxis Recommended  

Patient Declines Chemoprophylaxis  

Personal Information and Privacy

Any personal information or personal health information submitted in writing will be collected, used and disclosed by members of Regional Council and Regional staff in accordance with the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act, where applicable.

Freedom of Information

Any information you share will be used only for the intended purpose for which it was provided. If you have any questions, email or call 905-980-6000 ext. 3779.

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