%%EOF H��Wmo�6�n����a��WI@Q�I֬� Facilities with more than one type of setting will need to apply this table to each setting. The Tuberculosis (TB) Clinic is located at 400 E. Gray Street. 313 0 obj <> endobj ����x�L�� ����o}WOp�d^���j���IO�z�h�1�pgS�;Hi���H���in�� \�w�g��ӎ��V�O�M^,�̩�{�އU���g�yf���.�.#�����tU�E�w#l���d�vz�|�g�rܧ˳e�nڃ�(��������`D��G��@��燊���ų Tuberculosis (TB) Risk Assessment Form.
Missouri Department of Health and Senior Services Bureau of Communicable Disease Control and Prevention . 9�'*���R�-��A�\`Dr+ӶΧ$l|��g�֕��O���f����C���� d�g"���N7�&2ݓ���N�[;�����dV�\b�F�% Review the following risk factors before deciding to test. 4"�����O��1��@3eo{���H,�Gr�Q�7O���z޸ʙQ�V|��ӈ /��� �������ښ�U�3t�j�Ӹx�p��X�h�杶[ � ��:�8Զ����i�+ܴm~�n��y���>X�ϯ`i�~p@;!

b���d�ݦ� 380 0 obj <>stream MO 580-3015 (03-14) C. Medical Evaluation (Section C to be completed by Health Care Provider – if needed) endstream endobj startxref 1. TARGETED TB RISK ASSESSMENT . Santa Clara County Public Health Department TB Risk Assessment for School Entry This form must be completed by a licensed health professional and returned to the child’s school. California Adult Tuberculosis Risk Assessment and User Guide (September 2018 version) (PDF) California Pediatric Tuberculosis Risk Assessment and User Guide (September 2018 version) (PDF) California Tuberculosis School Staff and Volunteer Risk Assessment, User Guide, Certificate of Completion, and FAQs (PDF). sJ�U(՚{am0��cmx,�hHx�K`A�u��.Dt%+���!� �#w���`�Tk������"&�8mP�p�c.o� �� endstream endobj startxref ��]nY��T�-�Z�2��=��O��^Pp+`��������+g���T[cr*�.�=���C�����e��Ӯ��o�N�:�ntz��O��9�NtMF7}l�]ۇ�2�ː�t~ SCC TB Risk Assessment Form_Revised 3-18-2019 1 Santa Clara County Public Health Department Tuberculosis (TB) Risk Assessment for School Entry This form must be completed by a U.S. licensed primary care provider and returned to the child’s school. 01-15-16 Perry County Health Department to provide test results and preventive therapy to those testing positive for TB. Tuberculosis (TB) risk assessment worksheet This model worksheet should be considered for use in performing TB risk assessments for health-care facilities and nontraditional facility-based settings. 11. %PDF-1.5 %���� 40 0 obj <> endobj

�i]`���:dɐ�"���!w��Ųl�/��&��Y�9����?%( �B�Ԉ�k��Q#uBi�$��/W�B d���+a��h��Ў��aX2F�� Was your child born in, or has your child resided in or traveled to (for more than ����{�'���$� �{l��i��q��G��6���ٵ/���t�@Z��Z���Z�蔹b"��*`���BäԎ�P1�CHI��m�/��P��,7�� The local health department will perform additional testing for individuals with a chest X‐ray that is suspicious for TB. Clients with symptoms of TB or any of these risk factors are at a greater risk for TB infection or disease and should be tested. )0� �I�H|n[�O˶�J��Sx{�:��:[��}P��u�Oo�)�{s~X �o����p6�>�9��\5o1�����c��>R��n UJ�P�hzPU��2W�t��Wq*Wqz�pw5}���c��$�(e �Ҳƹ1�xn1������c�����Ѝ-D�ɇ�σ��[����Fnz����З[�y�郎f�?5���m����� ���Yy��:�>.A�X���!5 y鳘�������+G8���.E�r��X�z�3���f��8,]�1j�Zk���vXn'~!��*�L'���rL�jڅ�^A����W�h8o�P.�r��� X�[^���1L��Y]B܋��9hL�J��sӒ5N�~>'���I�'�mp�Q78J�|��m}�~�k�O&�.C%���F#i[�rI��d���*YTh���[%�5�D�&Kɻ�H��a�O�[��� 0�P)�:)����[���ٵ�ګ������H��^�P�H5���J�Rngl��%C p;��U�^T��| }����3z; $Ϙ�� l��:��3�X�ʑ�j�h�����npl��O&{"=��0�&,�Q@�npd+�,o����U2m{�5E�����>qM�j{�����eNl@�p����)b�b�����ڦ�E8�Y:v�y(��Ft�业} �j���̸���'�R"iv�}��:�TRÁv�B!�W߲���CЬ؄I�P��k��t����B���ǚ�ܦ�[����jhN��pEC%n�. ;0i7 ���u�"@��)��,�4�L��$cC�|;i/H܍$b�$Mg`bd`v�"�30�� 0 �� tuberculosis (TB) risk assessment be administered and if risk factors are identified, a TB test and examination be performed by a health care provider to determine that the person is free of infectious tuberculosis. %%EOF e��~�s~pT. iD��|)��n/H�YV ��7���,IX�ڀRV!5.Y�sky-��I�c���-��X.X�o1)8�+_b��G��5���)��)>;,�%Ґ�ҀoF���6�[ְ��ST�,bۥ�y]m��]�{#�L�]&W�{�]%��^�qO��S�S�ή ����������L��Y8J���4[��|Q�(�mܛ���,T�›"�S��K)����HD ~�D`��l�E�4�" ��� �ʒd�~�$��q��$�;KB �[I�E�/��_ƒPB�" %|n%��R ;WsH�ː�o��������ͱT��"�OF�k����n_�҂�� ��6Y^�R��� �3 1. 0 Background. Scoring √ or Y = Yes X or N = No NA = Not Applicable 1. h�bbd```b``v�5 �����"5@$;7�d� "Y���. endstream endobj 41 0 obj <> endobj 42 0 obj <> endobj 43 0 obj <>stream 338 0 obj <>/Filter/FlateDecode/ID[<3DA2F7006CA67246B3F4E5DC31951E07>]/Index[313 68]/Info 312 0 R/Length 125/Prev 451505/Root 314 0 R/Size 381/Type/XRef/W[1 3 1]>>stream As we continue to offer clinical services with a reduced number of staff, we have modified our schedule as follows. A contact investigation is a process to find out if any of the patient's contacts (friends, family, co-workers, etc.)

endstream endobj 318 0 obj <>stream Please call 574-6617 to make an appointment for chest x-rays, physician visits and referrals, and TB skin h�b```�=�R�� ��ea�X��p��ff���iPi�79��'�C �|l9��V�����^�����с��l클8K�y�W`n���� µ�шQ���A�@��).��P�g_�?��A�[J��D���j�#�43(�0�@�����N0���@� ?j+� Appendix B. 01-18-16 Public Health confirms 47 people with TB infection in Perry County. Facility Tuberculosis (TB) Risk Assessment Worksheet for Health Care Settings Licensed by MDH* Updated 6/24/2020. Kentucky Department For Public Health Instructions for the TB Risk Assessment Purpose of Form The TB Risk Assessment Form is a tool to assess and document a patient's TB symptoms and/or risk factors. ��u"y�����25N� ���e�=_��q!�0H��Ĝ�"�Mڒ�4��~��,s���Z��=� This tool can be used for school-aged children to determine if a student should have a TB test. k^�]텃$:�\C��B ��>l @cG��E�W9 �-�jlW��m��ޣ��I�^��b��". Yes No 2. ��0f7-c�c7``�,�x|����:���L�K@Fq30Z@��r ��R
x�]��j�0��~ The state TB prevention program aims to eliminate TB as a public health issue by coordinating and focusing disease-control activities on three main goals: Rendering all individuals with active TB disease as non-infectious. ��UO����I)}�blQ?��޵ݎh������s0&r�z�E8�t�Y����͵ZJ����͚b!���CZ�"\O�SZcs�%����>�3m�5��;`�5X�X�&�2S���X��–pc���|�,�u=������� ��n$> �]���7��W���WP��uiJ�� ��;( �yo��Ꮄ��4b��.

76 0 obj <>stream �Cq�K{��c�C��l��JfXd�8���d/t0� �����}i�'�7���'�8��-B��'u��y����v2Qi��uN8�4Uנ�E���{r�����!{a�y���qBJP������x5�.ؾu�����s|����068���ȆFTu%�@�*�($�Oߨ~�_���x����X��{������,y�J����C�T>? When a case of TB is reported to the Office of Public Health (OPH) TB Control Program, the first two steps are starting the patient on treatment as quickly as possible and conducting a contact investigation. endstream endobj 314 0 obj <>/Metadata 11 0 R/Pages 311 0 R/StructTreeRoot 31 0 R/Type/Catalog>> endobj 315 0 obj <>/MediaBox[0 0 612 792]/Parent 311 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 316 0 obj <>stream t��}H�A�G�me�< �~�-�a*7A��#���{Ȧ�ٛ7�O��X��-���d��[˖�x��x�q�"�Ն���ܲX . The clinic operates: 8:00am-12:00pm and 1:00pm-5:00pm Monday, Tuesday, Wednesday, Friday 10:00am-12:00pm and 1:00pm-5:00pm Thursday Appointments are required and walk-ins are not accepted. !oP h��VmO�8�+�qѪ��v"���R���E�w�T�C��)m�$����ݴIZ(��;E���gl?�3�́ Z ��� c :�HG�p+�x�?m�n �x̰?���@c8e�D�&���]RG�}._��Q�T��0ܝ��|Y�n�P)/*r�E�׋��bL^�T�E�8��$����}����8��[��d�E�x0:[7G��~c"���6� _�~7��|�� 59 0 obj <>/Filter/FlateDecode/ID[<222F9050A664630F4EBDEB543C15A565><1A91A4961EB3D94C8CD1314FA3EE7CC1>]/Index[40 37]/Info 39 0 R/Length 93/Prev 110204/Root 41 0 R/Size 77/Type/XRef/W[1 2 1]>>stream ��ǣ�u�� �*ٟ��������C6�q�wu������ʧo���S>��-�MV�fz���q��L�^0!x���a�8.�$l�Gl �׷)�����.`�76�8���T{g!$W�����L��m�l+#��h��ᶱl��t�-d��m1�V�x��Q�m ����pzQ�u��C�}Y�=�J��Ԟ"UE� �)��P��xC�0G��>l��D���w����D\��"��-�H���wS��4�B|g���*��p"}ÿu8�!l�[d��~�/U8���6�������} F@�nP�{�N+" Was your child born in Africa, Asia, Latin America, or Eastern Europe? Directions for Completing the Form %PDF-1.5 %���� 0 h�b``�c``rb`b`X������b�,Cx��b@D��H�Xm(Pl���� 01-11-16 Health Department to hold town hall meeting on TB Jan. 14 in Marion

Ensuring all individuals with latent TB infection remain non-infectious. g�;:8�����^�b�}d$�Dd���UG��/���`T}{�o�ӟ������B�����P��f����υw�:���rx3�;Uuo�����4;�x9 ngX��l2�M~��9��3�]�H��l8j��F_sɗ�]S����v ���\~Y�RV�s�_�oG������b���T���O�W��;�e���|2��j ����Zf�~�� �cc�[l$!eocͥ����3?�8�c���q�����6a�]v� ���ak��6�t�5��Mtq U��zKa�%�|5�(ex�3�0W0�+yK{�}��L,��7���:�V�+b��R��?�Zb�f ci������p|[]LJ��p�~6�����ӎKf�c��M@�*��LU?���o�M���UF�,+%�����pm�M��M������(z�T��1ؗ�T�(��Uz� Tuberculosis Testing & Risk Assessment Cabell-Huntington Health Department clinic staff have been busy working many of the public health aspects of case investigation during COVID-19. h�bbd``b`Z$�� ��H0_� � �����A���"H[(�0 se����X8�������Lf`����G� 5�> have also been infected. Completing this form will also help in determining the need for further medical testing and evaluation. CT TB Risk Assessment and User Guide_July 2019 Page | 1 Connecticut Tuberculosis (TB) Risk Assessment See the Connecticut TB Risk Assessment User Guide for more information about using this tool. Any person with a positive skin test and signs of active TB must not attend class or work until cleared by the Alabama Department of Public Health. Use this tool to identify asymptomatic adults and children for latent TB infection (LTBI) testing. h��X�n7�>&(��uHA _I


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