ceroiz016 10:14 om 9011001 ry a PEBBLE BEACH HEALTH & WELLNESS CENTER 220 COUNTRY CLUB GATE CENTER, SUITE 27 PACIFIC GROVE, CA 93950 PHONE# 831-649-2710 FAX# 831-373-8845 TB SKIN TEST (PPD) Have you ever had a POSITIVE reaction toa TB skin test? Yes >No Have you received the BCG vaccine for TB? aves No Date this test administered: FY LQIIFF site!-AKN dose: Olen. Loti 7237 exp: Oifflo Marstnitiats CXC Time: ||" VICE PATIENT TO RET 4 FOR READING! Erythema: 27 __mm. (Enter Neg. if. None) Induration:__-€7_mm. (Enter Neg if Nowe) MA’s Initiais:_ ft Date:_ 5} 14 S Time__[~oo INTERPRETATION POSITIVE REACTION: Any palpable induration measuring 10 mm is considered a positive reaction. In the case of tuberculosis suspects or close contacts of individuals with tuberculosis an induration of 5 mm or even smaller should be interpreted as 2 Positive reaction and appropriate’ additional follow-up measures indicated. DOUBTFUL REACTION: Induration measuring $-9mm indicates a doubtful reaction. Retesting is indicated using w different site and STU per test dose, The possibility should not be excluded that the skin sensitivity is due to previous contact with a typical micro bacteria or previous BCG vaccination. NEGATIVE REACTION: Induration of less than Smm is considered negative,