Me WILKES UNIVERSITY f TUBERCULIN TEST PERMIT name Emma Feels wine. 100 [Hod 2S pate_!/ 1c /2024 pos !2/27/2002 CELL PHONE Cel “W132 - 5995" Please read the following statements: 1. Tomy knowledge | have never reacted to a Tuberculin test. 2. Iwill return in 48-72 hours to have test interpreted. 3. Ihave read the statements and give my permission for a Tuberculin Test. signature Uva. Saul 5 HUGG sea Date given, Lot Number___2CA92C2. Exp. Date oe : 2y esutts NN read Follow-up. Significant Reaction: Ihave had a previous Tuberculin Test and declare that | am a significant (positive) reactor. Therefore, | decline skin testing at this time. ignature of employee/student Health Care Proy REV. 113.ab