LTBI Completion Cards on Avery8871 Template



Latent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:261112011874500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:263017013525500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTLatent TB Infection (LTBI) TEST & TREATMENT completion CARD Show this card to the doctor, so they know about your past LTBI testing and treatment Call your doctor if you have any of the following symptoms for 2 or more weeks:263017013525500 Cough Weight loss without trying Fever and chills Night sweats Coughing up blood Feeling weak and tired RETAIN THIS DOCUMENTName:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________Name:_________________________________ ____________TST mm induration Date Read: ______ ____IGRA Pos. Neg. _ Date:_ ___ _Latent TB infection treatment completed: Yes No__Drug(s): ____________________Duration:_________Clinic:______________________________________________City, State:__________________________________________685800458470003886200458470006858002287270003886200228727000685800411607000388620041160700068580059448700038862005944870006858007773670003886200777367000 ................
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