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Tuberculosis (TB) Screening and Testing …

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Student health & Wellness University of Iowa 4189 Westlawn Iowa City, IA 52242 Name ________________________ Address ________________________ ________________________ University ID _________________________ Tuberculosis (TB) Screening and Testing Questionnaire CIRCLE ANSWERS 1. How old are you? ____________________________ 2. Have you ever had a vaccine to prevent Tuberculosis (BCG vaccine)? (Usually given as infant or child. You may have scar on your arm from the vaccine) NO YES UNKNOWN 3.

Student Health & Wellness University of Iowa 4189 Westlawn Iowa City, IA 52242 Name _____ Address _____

  Health, Testing, Screening, Students, Screening and testing, Student health

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