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TB Neg Symptom Form PDF
TB Neg Symptom Form PDF
Or 2) Physician requests student abstain from getting a Tuberculin PPD Skin Test at this time
o I have a doctor’s excuse to NOT obtain the Tuberculosis test at this time (attach physician’s note please). My
expected date to get the Tuberculosis test is ________________________.
If I abstain from getting the Tuberculin PPD skin test I acknowledge that I do not have any of the following
symptoms of active Tuberculosis and I understand that should I develop any of these symptoms I will immediately go
to the doctor for evaluation. I will also refrain from any clinical or class activity that may expose others to my
potential active case of Tuberculosis until the physician has cleared me.
Signature date