The Tuberculin Skin Test (PPD or Mantoux test) screens for latent tuberculosis (TB) infection. The official form serves as a formal, legal document recording the procedure, timing, and interpretation. This documentation is frequently required for administrative purposes, such as employment clearance, school enrollment, or immigration processes. Accurate and complete data entry is necessary to ensure a standardized record of potential exposure to the Mycobacterium tuberculosis bacterium.
Completing the Patient Data Section
This initial section establishes the identity of the person being tested before the test is administered. Accurate entry of the full legal name and date of birth is paramount for creating a unique, reliable record that prevents misidentification. Required demographic fields typically include a current address and reliable contact information, such as a phone number or email address. Many forms also ask for the specific reason for the test, such as annual requirements for healthcare workers or pre-enrollment for school. Since non-medical personnel often review this section, all entries must be legible and consistent with official identification.
Documentation at the Time of Injection
This section must be completed by the healthcare provider immediately following the intradermal injection. Precise documentation begins with recording the exact date and time of administration, which defines the mandatory 48- to 72-hour window for the subsequent reading. If the reading occurs outside this timeframe, the test is invalidated and must be repeated. The form requires documentation of the specific site of injection, typically the inner surface of the forearm, specifying the left or right arm. To ensure material traceability, the provider must record the manufacturer, lot number, and expiration date of the PPD solution used, and then sign or stamp the form, verifying the proper technique and materials were used to inject the standard dose of 0.1 mL of PPD.
Recording the Test Reading and Results
This section involves recording the result, which must be performed between 48 and 72 hours after the injection. The healthcare professional must document the date and time of the reading, confirming it falls within the acceptable window. The evaluation focuses on the presence and size of induration, the firm, raised, hardened area resulting from the reaction. Using a ruler, the provider measures the induration across the forearm perpendicular to the long axis, recording the finding in exact millimeters (mm). Surrounding redness (erythema) is not measured; if no induration is present, the result is 0 mm.
Interpreting Induration Size
The size of the induration is interpreted as Positive or Negative based on the patient’s individual risk factors. For example, 5 mm or greater may be positive for individuals with recent TB contact or weakened immune systems (e.g., HIV). Conversely, 15 mm or greater is required for persons with no known risk factors. The reading provider must sign and date this section, certifying the accuracy of the measurement and interpretation based on clinical guidelines.
Finalizing the Form and Submission Protocol
Once the medical sections are complete, the form requires a final review to confirm all fields and necessary signatures are present. The final step often involves a patient acknowledgement signature, confirming they have been informed of their results and any necessary follow-up steps. The patient should obtain a copy of the completed form for their personal medical records before it leaves the clinic. The original document is then prepared for submission to the requesting entity, such as an employer’s Human Resources department or a university’s admissions office. Submission must be prompt, using the entity’s specified method (secure email, fax, or hand delivery), to meet required deadlines for clearance or enrollment.