TB Results

TB Results Part 1
PPD (Mantoux)
Steps*
Name
First NameLast Name
Company
Company
If not in Drop Box
Email
example@example.com
Brand of TB (PPD) Test:*
Site of TB Placement:*
Lot#*
Exp. Date*
Administered By:*
Supervising MD:
Billing
Date Administered*
MonthDayYear
Date
Result:
Date Test Read
MonthDayYear
Date
Induration in mm
Test Read By:
Chest X-Ray Needed
Signature of Supervising Physician:
If you are completing a 2 Step TB Test you will need to return within 7-21 days to have your second test placed.
Accurate Diagnostics -Greenville 1635 East North Street Greenville, SC 29651
Website: www.testforthat.com Phone: 864-271-3306

TB Results Part 1