TB TEST RESULTS
PATIENT: ______________________________
EMPLOYER: ____________________________
LOT#: ____________________
EXPIRATION DATE: _______________
DATE TEST COMPLETED: _______________
FOREARM:
LEFT
RIGHT
ADMINISTERED BY: _________________________
RESULTS: __________________
DATE READ: ____________________
READ BY: _____________________________
RESULTS MUST BE SENT TO HUMAN RESOURCES
3510 N. Causeway Blvd.
Suite 404
Metairie, LA 70002
FAX# (504)779-5568