Latent TB Infection: Diagnosis and Treatment Guide

The Latent Tuberculosis Infection Mobile App will be retired September 15, 2017.

Visit the Latent TB Infection Online Hub for clinical information, guidance, fact sheets, and messages on targeted testing recommendations for latent TB infection.  Updates about future mobile app developments will be posted here as well.

Diagnosis

Sample Documentation Forms

Record of TB Skin Test

To Whom It May Concern:

The following is a record of Mantoux tuberculin skin testing:

  • Name:
  • Date of birth:
  • Date and time test administered:
  • Administered by:
  • Manufacturer of PPD:
    • Expiration date:
    • Lot Number:
  • Date and time test read:
    • Read by:
  • Date:
  • Results (in millimeters of in duration)

Record of Interferon-Gamma Release Assay for TB

To Whom It May Concern:

The following is a record of IGRA results:

  • Name:
  • Date of birth:
  • Type of test:
    • Date:
    • Laboratory:
  • Qualitative result:
    • Nil (IU IFN-?):
    • Mitogen (IU IFN-?):
    • M. tb antigens (IU IFN-?):

 

Diagnosis

Sample Documentation Forms

Record of TB Skin Test

To Whom It May Concern:

The following is a record of Mantoux tuberculin skin testing:

  • Name:
  • Date of birth:
  • Date and time test administered:
  • Administered by:
  • Manufacturer of PPD:
    • Expiration date:
    • Lot Number:
  • Date and time test read:
    • Read by:
  • Date:
  • Results (in millimeters of in duration)

Record of Interferon-Gamma Release Assay for TB

To Whom It May Concern:

The following is a record of IGRA results:

  • Name:
  • Date of birth:
  • Type of test:
    • Date:
    • Laboratory:
  • Qualitative result:
    • Nil (IU IFN-?):
    • Mitogen (IU IFN-?):
    • M. tb antigens (IU IFN-?):

Diagnosis

Sample Documentation Forms

Record of TB Skin Test

To Whom It May Concern:

The following is a record of Mantoux tuberculin skin testing:

  • Name:
  • Date of birth:
  • Date and time test administered:
  • Administered by:
  • Manufacturer of PPD:
    • Expiration date:
    • Lot Number:
  • Date and time test read:
    • Read by:
  • Date:
  • Results (in millimeters of in duration)

Record of Interferon-Gamma Release Assay for TB

To Whom It May Concern:

The following is a record of IGRA results:

  • Name:
  • Date of birth:
  • Type of test:
    • Date:
    • Laboratory:
  • Qualitative result:
    • Nil (IU IFN-?):
    • Mitogen (IU IFN-?):
    • M. tb antigens (IU IFN-?):
Syndicated Content Details:
Source URL: http://www.cdc.gov/tb/publications/LTBIapp/appendixE.htm
Source Agency: Centers for Disease Control and Prevention (CDC)
Captured Date: 2016-05-23 22:32:32.0

 

 

 

 
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