Annex 4. Health care worker tuberculosis screening form

This tuberculosis (TB) infection screening form is based on a publication from the United States Centers for Disease Control and Prevention (CDC) (1). It is intended for screening health care workers periodically for TB. Other health screening (e.g. for diabetes, HIV, hypertension or malnutrition) can be added to this form as needed.


HIV: human immunodeficiency virus; ID: identity; TB: tuberculosis; TPT: TB preventive treatment.

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