Tuberculosis Skin Test Results
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1Tuberculosis Skin Test Results
One Step Tuberculosis (TB) Skin Test
Patient’s Name (print please) ________________________________________
Date Given:
______________
Date Read:
______________
Results: ______ mm
Negative
Positive
Is there any follow-up required?
No
Yes (If yes, please detail below)
___________________________________
__________
Signature of Person Reading Results
Date
Address or Stamp of Clinic where test was performed:
Results may be Mailed or Faxed to:
Faulkner University
Health Clinic
Phone: 334-386-7183 or 334-386-7184
5345 Atlanta Hwy
Fax: 334-386-7180
Montgomery AL 36109
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Parent category: Medical