Printable blank TB Test Result Form

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PPD Skin Test (also referred to as the tuberculin, Mantoux, or the Tuberculosis Test) is used to determine if a person has a silent (or latent) tuberculosis infection in their lungs. The Tuberculosis Test is often used by healthcare providers in lieu of the standard blood tests for TB. Usually, this test is used in children who are under five.

What You Need PPD Skin Test Form For

PPD Skin Test form is used to document the results of the aforementioned skin test. Many people in the US who are infected with TB-causing bacteria do not show any active symptoms of this dangerous disease. Therefore, they need PPD skin test (and i.e. PPD Skin Test form), especially if they:

  • Have interacted with someone with TB;
  • Work at a hospital;
  • Have weak immunity as a result of taking certain meds or being exposed to certain diseases.

How to Fill out the PPD Skin Test Form

It should be stressed that the PPD Skin Test form is filled out by your healthcare provider in several steps. The upper section of the document needs to be filled out upon making the injection. The lower section is to be completed when the results of the tuberculin test are ready (usually within up to 72 hours after the procedure).

Aside from the details on your PPD skin test results, the form should include the following information:

  • Your and your doctor’s names.
  • Location of the healthcare facility where the test was administered;
  • Expiration date;
  • Date when the test was done;
  • Date when the results were read;
  • Your doctor’s signature.

Organizations that Work with the Mantoux Skin Test Form

  • School administrations
  • Military facilities
  • Healthcare facilities, etc.

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