Do I Get a Ppd Skin Test Again if Previously Positive

For the General Public:

What is TB?
What are the symptoms of TB?
How is TB spread?
Is there a difference betwixt TB Infection, and TB disease?
What should I exercise if I take spent fourth dimension with someone with TB infection?
What should I exercise if I have been exposed to someone with TB illness?
How do I become tested for TB?
Who can administrate a tuberculin skin test (TST)?
How often can TSTs be repeated?
Where can I get tested for TB?
What does a positive TB exam mean?
Can I go vaccinated for TB?
What if someone has received the BCG vaccine (which is given in many countries)?
Why is TB infection treated?
How is TB disease treated?
How many people in Texas take TB?

For Health Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon rent?
How often should HCP be screened for TB after hire? Is annual testing recommended?
If almanac testing with a TST or claret examination is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?
How should I screen my employee for TB upon hire if they say they already have a positive TB skin or claret test?
Can a new hire's documented negative tuberculin skin test (TST) result be used in performing a baseline two-step TST?
What do I need to know if my HCW has received a BCG vaccine?
Are routine or annual CXRs nonetheless recommended?
Can my employee with a positive TB pare or blood exam render to work?
What further actions do I demand to take when HCP are diagnosed with TB infection or TB illness?
Should HCP exist treated for TB infection?
Take the updated 2022 guidelines for screening HCP for TB changed the need for a facility hazard assessment?
Does DSHS take a sample form that health care facilities may utilise to document TB screening, testing, and education?
Where can I notice more information regarding screening health care personnel for TB?

TB and COVID-nineteen

Exercise COVID-xix and TB share similar symptoms?
Are in that location recommendations to delay TB screening in persons recently vaccinated against COVID-19?

General Reporting Requirements

How do I report tuberculosis screening results?

Recommendations for TB Screening of Adults and Children in Various Settings

Are there general recommendations most which adults should and should not be screened for TB in Texas, and how to screen them?
Are there full general recommendations about which children should and should not be screened for TB in Texas, and how to screen them?
What are the screening requirements for TB testing in facilities that provide care to children?
What are the screening requirements for TB testing in adult intendance centers such as assisted living facilities?

For Schools

Do all employees in Texas schools nonetheless demand a tuberculin pare test?
Practice all new students in Texas schools still need a tuberculin peel test?

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

Other Resources

What are other recommended sites where I can find data about tuberculosis?

For the Full general Public

What is TB?

Tuberculosis (TB) is a illness caused by germs that are spread from person to person through the air. TB usually affects the lungs, but it can also affect other parts of the torso, such as the encephalon, the kidneys or the spine. A person with TB tin die if they exercise non get treatment.

What are the symptoms of TB?

The general symptoms of TB disease include feelings of sickness or weakness, weight loss, fever, and dark sweats. The symptoms of TB disease of the lungs as well include coughing, breast pain, and the coughing upwardly of claret. Symptoms of TB disease in other parts of the body depend on the area affected.

How is TB spread?

TB germs are put into the air when a person with TB illness of the lungs or throat coughs, sneezes, speaks or sings. These germs tin can stay in the air for several hours, depending on the surround. Persons who breathe in the air containing these TB germs can get infected; this is called TB infection or latent TB infection (LTBI). If untreated, TB infection can get TB illness.

Is at that place a difference between TB Infection, and TB disease?

People with TB infection accept TB germs in their bodies, simply they are not ill because the germs are non active. These people do non have symptoms of TB disease and they cannot spread the germs to others. However, they may develop TB disease in the future. They are oftentimes prescribed treatment to prevent them from developing TB illness.

People with TB illness are ill from TB germs that are active, meaning that they are multiplying and destroying tissue in their torso. They usually have symptoms of TB affliction. People with TB disease of the lungs or pharynx are capable of spreading germs to others. They are prescribed drugs that can care for TB disease.

What should I practice if I accept spent time with someone with TB infection?

A person with TB infection cannot spread germs to other people. Y'all do not need to be tested if you have spent time with someone with TB infection. Still, if you have spent time with someone with TB illness or someone with symptoms of TB, you should contact your doctor or local or regional wellness department for TB screening recommendations.

What should I exercise if I have been exposed to someone with TB illness?

Not everyone who is exposed to TB becomes infected with the TB germs. If y'all believe you accept been exposed to TB, y'all should contact your doc or the local health department for more data nearly screening and testing.

How do I get tested for TB?

There are two tests that can exist used to assistance observe TB infection: a skin exam or a TB blood test.

The Mantoux tuberculin skin test (TST) is performed by injecting a small amount of fluid (chosen tuberculin) into the peel in the lower office of the arm. A person given the TST must return inside 48 to 72 hours to have a trained health care worker await for a reaction on the arm; this must be washed in-person.

The TB blood exam, known as the Interferon Gamma Release Assay (IGRA), measures how the patient'south immune system reacts to the germs that cause TB when nowadays. There are currently ii Federal Drug Assistants (FDA) approved claret tests on the market: the QuantiFERON®–TB Golden In-Tube test (QFT-GIT) and the T-SPOT®.TB test (T-Spot).

Although the tuberculin skin exam has been the about common screening method in Texas, many health departments now use the IGRA test equally the standard tool. When choosing a skin test or claret test, consideration can be fabricated based on age, health status (see policy TB 1004), BCG status, and other factors of the person needing the exam.

A positive TST or IGRA but tells you lot if you have TB germs in your body. Other tests may exist needed to tell if yous have TB disease, such equally a chest x-ray (CXR) and other laboratory testing of sputum.

Who can administer a tuberculin skin exam (TST)?

A tuberculin skin test (TST) is considered a medical human activity and should simply be performed by an individual working under the guild of a licensed medico. There is no requirement for the individual to be a licensed health care worker. DSHS recommends those that administer a TST meet knowledge and clinical skills requirements, have received grooming, and demonstrated competency before administering a TST.

The Texas DSHS TB Programme recommends that anyone who administers a TST has reviewed, is familiar with, and able to readily access the recommendations within the post-obit documents:

CDC Fact Sheet "Tuberculin Pare Testing"
CDC fact sheet "Targeted Tuberculin Testing and Interpreting Tuberculin peel Test Results"
CDC Mantoux Tuberculin Pare Testing Facilitator Guide
Tubersol package insert (PDF)
Aplisol parcel insert (PDF)

In person preparation on how to administer a TST is bachelor through the Heartland National TB Centre. Delight visit the Heartland National TB Center website for a listing of training opportunities.

How often can TSTs be repeated?

In general, in that location is no adventure associated with repeated tuberculin skin test placements. If a person does non render inside 48-72 hours for a tuberculin peel test reading, a 2nd test can be placed as soon equally possible. There is no contraindication to repeating the TST, unless a previous TST was associated with a severe reaction.

Where can I become tested for TB?

In general, Texas Department of State Health Services does not recommend that low risk individuals exist tested for tuberculosis. If a test is needed or recommended, the full general public may ask their principal care provider, local clinics, or pharmacies, among other sites. You may also contact your local or regional wellness department for recommendations regarding private testing needs.

What does a positive TB test hateful?

A person with a positive TST or blood examination has the TB germ in their torso. It does not tell whether or not the person has TB infection or TB affliction. Other tests, such equally a chest ten-ray, symptom screening and a testing of sputum (phlegm), are needed to determine whether the person has TB infection or TB affliction.

Tin I become vaccinated for TB?

There is a vaccine for TB, all the same it is not generally recommended for employ in the United States. Bacille Calmette-Guérin, or BCG, is a vaccine used in many countries with high rates of TB. BCG vaccination does non completely prevent people from getting TB, but information technology is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis.

What if someone has received the BCG vaccine (which is given in many countries)?

In many parts of the world where TB is common, Bacille Calmette-Guérin, (BCG) vaccine is used to protect infants and young children from serious, life-threatening diseases, specifically miliary TB and TB meningitis. However, it does not completely prevent people from getting TB.

The effect of the BCG vaccine wanes overtime and may have little to no issue on positive TST results among adults who received the vaccine as a child.

A person with a history of BCG vaccination tin be tested and treated for TB infection if they react to the TST. TST reactions should be interpreted based on chance stratification regardless of BCG vaccination history. IGRAs apply M. tuberculosis specific antigens that do non cross react with BCG, and therefore, do not cause fake positive reactions in BCG recipients— this ways a blood test, or IGRA, is preferred for BCG vaccinated individuals.

Why is TB infection treated?

If you lot have TB infection but not TB disease, your doctor may desire y'all to take a drug to kill the TB germs and prevent you lot from developing TB illness. The decision about taking handling for TB infection will be based on your chances of developing TB disease. Some people are more than likely than others to develop TB affliction once they accept TB infection. This includes people with HIV infection, people who were recently exposed to someone with TB disease, and people with sure medical conditions.

How is TB illness treated?

TB illness can exist treated by taking multiple drugs for several months, generally 6 to 12 months. It is very important that people who have TB affliction stop the medicine, and take the drugs exactly equally prescribed. If they finish taking the drugs too presently, they can get sick again; if they practise not take the drugs correctly, the germs that are yet alive may become resistant to those drugs. TB that is resistant to drugs is harder and more expensive to treat. In some situations, local health department staff meets regularly with patients who have TB to picket them take their medications. This is chosen directly observed therapy (DOT). DOT helps the patient complete handling in the least amount of time.

DSHS provides TB medications to public health clinics across Texas. These clinics treat patients with TB disease. Besides, people who are presumed to take TB may be given treatment while their clinicians perform further testing to confirm or rule out TB disease.

How many people in Texas have TB?

Each yr, DSHS provides data on numbers of TB cases per canton. The most current information is found on the TB statistics folio.

For Wellness Care Professionals

What are the recommendations for screening health care personnel (HCP) for tuberculosis upon hire?

The Department of Land Wellness Services (DSHS) in partnership with the National Tuberculosis Controllers Association (NTCA) and Centers for Disease Control and Prevention (CDC), recommend that both paid and unpaid health intendance personnel (HCP) receive the following upon hire:

A single blood examination known as an interferon gamma release assay (IGRA) or a 2-step tuberculin skin exam (TST);
An private hazard assessment to make up one's mind baseline risk for TB and translate the IGRA or TST results; and
A signs and symptoms screening assessment.

DSHS has developed a sample Baseline Tuberculosis Assessment for Health Intendance Personnel grade (PDF) that may be used by wellness intendance facilities. DSHS likewise recommends completing the Tuberculosis Screening Results and Piece of work Clearance for Wellness Intendance Personnel (PDF) later on performing a baseline TB assessment.

These recommendations may be used past wellness care facilities and other entities to guide the evolution of their internal TB screening policies. These recommendations should non be interpreted as DSHS policies.

How often should HCP exist screened for TB subsequently hire? Is almanac testing recommended?

Annual TB testing using an IGRA or TST is not routinely recommended. Health intendance facilities should perform TB testing and consummate a signs and symptoms assessment after known or ongoing exposure to TB or consummate a signs and symptoms assessment annually for HCP with untreated TB infection. HCP should also be educated near TB treatment options for TB infection.

DSHS has developed a sample Later Hire Tuberculosis Assessment for Health Care Personnel form (PDF) that may be used for HCP with untreated TB infection or anytime a HCP is tested for TB afterward hire.

*Almanac TB testing using an IGRA or TST and symptom screening may be considered for HCP with significant occupational adventure, such every bit pulmonologists or respiratory therapists in loftier risk settings, or in settings where TB exposures take occurred in the past (i.e. emergency departments). This decision should be developed by the health intendance staff responsible for infection control and may be done in collaboration with your local health department.

If almanac testing with a TST or claret exam is no longer routinely recommended, should HCP be checked for symptoms of TB periodically?

DSHS recommends that facilities consider the local epidemiology of TB in their county (PDF), including risk factors for TB (PDF) [CDC] in their staff, and any past TB exposures in the facility when deciding to implement periodic TB screening after baseline testing. The purpose of screening for TB using a signs and symptoms assessment questionnaire is to ensure active TB is identified early. Anyone with symptoms of TB should be referred for medical evaluation.

How should I screen my employee for TB upon rent if they say they already have a positive TB pare or claret test?

HCP with documentation of a previous positive TST or IGRA result, or documentation confirming completion of treatment for TB infection or illness, should exist screened for TB in the post-obit way:

Complete a TB signs and symptoms assessment.
Accept a baseline chest x-ray (CXR) performed (unless a recent copy is available).

HCP with documentation of a previous positive TST or IGRA effect should not be re-tested with a TST or IGRA.

After the baseline screening, series or routine CXRs are not recommended; however, persons exhibiting symptoms of TB disease require a CXR regardless of history.

HCP without documentation of the previous test outcome should undergo baseline screening with a two-step TST or an IGRA. An private risk assessment (PDF) and signs and symptoms screening assessment should also exist completed (refer to Baseline Tuberculosis Assessment for Health Care Personnel (PDF)). Copies of the TB screening results and responses to the symptom screen and private take chances assessment should be kept by the employee every bit documentation in case of future screenings.

Tin can a new hire'southward documented negative tuberculin skin test (TST) result be used in performing a baseline two-step TST?

Yes, a new rent'due south documentation of a negative TST outcome tin be recorded every bit pace i of the two-stride TST when administered any fourth dimension during the previous 12 months, if the result was documented in millimeters (mm). The TST administered at rent will be recorded as step ii of the ii-footstep TST.

For more details, refer to the Guidelines for Preventing the Transmission of M. TB in Health-Care Setting, 2005 (PDF) [CDC] TB Infection-Control Surveillance.

What do I need to know if my employee has received a BCG vaccine?

The IGRA and TST are non contraindicated for persons who take been vaccinated with Bacillus Calmette–Guérin (BCG). The effectiveness of BCG wanes overtime but it may crusade a false-positive reaction to the TST, which may complicate decisions about diagnosing TB infection and prescribing treatment. IGRAs use M. tuberculosis specific antigens that do not cross react with BCG, and therefore, do not cause false positive reactions in BCG recipients. This means an IGRA test is preferred for BCG vaccinated individuals. More than information tin can be found on the CDC website.

Are routine or annual CXRs nonetheless recommended?

No, chest x-rays should not be performed routinely or annually for persons with a positive IGRA or TST. Health care personnel, patients or institutional residents with a baseline positive or newly positive IGRA or TST upshot who are likely to be infected with TB should receive one chest radiograph to exclude a diagnosis of TB disease. Repeat chest ten-rays are non needed unless signs or symptoms of TB develop, or a clinician recommends a echo breast radiograph, or after a new exposure to TB.

Health intendance personnel who accept a previously positive IGRA or TST result and who change jobs should carry documentation of the results of their IGRA or TST, chest radiograph and documentation of treatment history for TB infection, if applicable, to their new employer.

Can my employee with a positive TB skin or blood test render to work?

HCP who are likely * infected with TB based on a positive TST or IGRA result and individual risk, should exist referred for a CXR and medical evaluation to rule out active TB prior to returning to piece of work. If a diagnosis of TB infection is fabricated, HCP may return to piece of work, as TB infection is not contagious. They should be educated on treatment options for TB infection to minimize their chance of developing TB disease.

HCP who are asymptomatic, unlikely* to exist infected with TB, and who are at depression take a chance for progression to TB disease based on individual risk, should have a second exam (either an IGRA or a TST) if their first test is positive. Only when the second examination is positive in low run a risk individuals is TB infection considered an accurate diagnosis (PDF).

What further actions practise I need to take when HCP are diagnosed with TB infection or TB affliction?

TB infection, TB disease, and suspicion of TB disease are all reportable to your local health section. Meet How do I report TB? for reporting requirements.

Should HCP exist treated for TB infection?

Treatment for TB infection should be considered in all persons to prevent the progression to TB illness. This determination should be made betwixt the HCP and their health intendance provider.

When facilities screen for TB, DSHS recommends that an almanac education component is included in the screening plan. Education can include information on signs and symptoms of TB, the difference between TB infection and illness, TB risk factors, and the risks for developing TB disease if not treated.

Accept the updated 2022 guidelines for screening HCP for TB changed the demand for a facility take a chance cess?

No, facility take a chance assessments are still recommended. The results of the assessment are no longer used to determine frequency of TB screening but are useful in documenting infection command in facilities. Refer to the CDC website for more than details on the use of the risk assessment and updates to the 2022 guidelines.

Does DSHS accept a sample form that health care facilities may apply to certificate TB screening, testing, and teaching?

Yes. DSHS has developed the following forms that facilities may utilise or modify to fit their need.

Baseline Tuberculosis Assessment for Wellness Care Personnel (PDF). It is intended for use in health care facilities when assessing employees for TB upon hire.
Later on Rent Tuberculosis Assessment for Health Care Personnel (PDF). It is intended for use in health care facilities when assessing employees for TB whatever time after baseline screening.
Tuberculosis Screening Results and Work Clearance for Health Care Personnel (PDF). It allows facilities to document results of baseline and subsequently hire screening including the recommended annual teaching.

These forms are not required by DSHS merely may be used to guide and certificate facility screening practices, as they align with DSHS and CDC recommendations.

Where can I notice more information regarding screening health care personnel for TB?

Refer to the Centers for Disease Control and Prevention (CDC) website for more information.

TB and COVID-19

Do COVID-19 and TB share similar symptoms?

Aye, TB and COVID-nineteen take some similar symptoms such as a cough or a fever. Merely a licensed healthcare provider can determine the cause of symptoms and farther testing may be needed. For healthcare providers, it is of import to "Think TB" when symptoms and hazard factors for TB are present. See Tuberculosis and COVID-19 Know the Divergence (PDF) for details.

Are in that location recommendations to delay TB screening in persons recently vaccinated against COVID-19?

No, TB screening should not be delayed for people with take chances factors for TB who accept been vaccinated against COVID-19. The Centers for Disease Command and Prevention (CDC) has information about TB screening practices and the COVID-19 vaccine.

Information technology is recommended that those in charge of TB screening visit the CDC website periodically for whatsoever updates regarding TB screening practices. When because the affect of TB in your area, please consult with your regional or local wellness department (R/LHD). Report suspected and confirmed TB infections to your R/LHD.

General Reporting Requirements

How exercise I report tuberculosis screening results?

Both TB infection and TB disease are Notifiable Conditions reportable to the local or regional wellness department TB Programs. Reporting details can be establish on the DSHS website, which include reporting forms.

Tuberculosis Infection- Reportable inside one (1) calendar week to the local or regional health department. A diagnosis of a latent TB infection is Non consummate until the following criteria have been met:

Positive skin test with results written in millimeters and date read, or positive IGRA blood exam results; and
Documentation that patient has no electric current signs or symptoms of active tuberculosis illness; and
CXR results that are read as normal, or not consistent with TB; and
In that location is no suspicion of Active TB disease

TB Disease or Suspicion of TB Disease- Reportable within one (1) working day.

Recommendations for TB Screening of Adults and Children in Various Settings

Are there general recommendations about which adults should and should not exist screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of adults in Texas, depending on identified TB adventure factors. Please refer to information in Tuberculosis Screening Recommendations for Adults in Various Settings (TB-1002) (PDF).

Are there general recommendations about which children should and should not be screened for TB in Texas, and how to screen them?

Yes, the DSHS TB Unit has recommendations for TB screening of children in Texas, depending on identified TB risk factors. Delight refer to information in Tuberculosis Screening Recommendations for Children in Various Settings (TB-1003) (PDF).

What are the screening requirements for TB testing in facilities that provide care to children?

Facilities with a allow or license from Texas Health and Human Services (HHS) to provide care to children volition abide past the capacity that utilize to each type of facility in the Texas Administrative Code (TAC) Championship 26, Office 1.

The Minimum Standards page on the HHS website contains links to the standards related to daycare facilities, 24-hour residential care, and kid-placing agencies. These links are located at the bottom of the page.

Any facilities that provide care to children and are not listed to a higher place should outset review the Texas Administrative Code for any statutory requirements or bank check with their licensing or credentialing agency. Collaboration with a local or regional TB program may aid in developing screening, testing, and handling plans.

What are the screening requirements for TB testing in developed intendance centers such as assisted living facilities?

Screening requirements for adults working in these facilities are outlined in the Long-Term Care Regulatory Provider Letter (PDF) :

Assisted Living Facility
Twenty-four hours Activity and Wellness Services Facility
Intermediate Care Facility for Individuals with an Intellectual Disability or Related Weather condition
Dwelling house and Community Back up Services Agency
Nursing Facility, and
Prescribed Pediatric Extended Care Heart

Facilities licensed past HHS for adult care in Type A and Type B Assisted Living Facilities will abide by Texas Administrative Code (TAC) Championship 26 Office 1 Chapter 553 Subchapter Eastward Rule §553.261B. TB requirements are summarized beneath; however, each facility should review the TAC for specific details:

Facilities must develop written policies for the control of communicable diseases in employees and clients, including TB screening and the provision of a safe and sanitary surround for clients and their families.
Screen employees for TB within ii weeks of employment.
Afterward hire, facilities must follow CDC guidance in Tuberculosis Screening, Testing, and Handling of U.Due south. Wellness Care Personnel: Recommendations from the National Tuberculosis Controllers Association and CDC, 2019. See FAQs for Health Intendance Professionals.
Facilities must screen residents for TB upon admission and afterwards exposure to TB.
Whatsoever facilities that provide care to adults and are not listed to a higher place review the Texas Administrative Code for any statutory requirements or check with their licensing or credentialing agency. Collaboration with a local or regional TB program may assist in developing screening, testing, and treatment plans.

For Schools

Do all employees in Texas schools nevertheless need a tuberculin peel examination?

There is no statewide requirement for teachers or other schoolhouse employees to accept a tuberculin peel exam or TB blood test. The Centers for Illness Command and Prevention (CDC) and DSHS discourage the utilize of the tuberculin peel testing or IGRA blood exam for persons who have no run a risk factors for TB exposure.

However, anyone with signs or symptoms of TB should be considered for medical evaluation.

Specifications for employee or volunteer TB screening may be required by a licensing, credentialing, or insurance policy, or by the school district'south regulations and requirements. Each schoolhouse should defer to their own policy.

Do all new students in Texas schools yet need a tuberculin skin exam?

No. A tuberculosis questionnaire has been adult by Texas Department of Land Health Services to identify children at high risk for TB infection. Refer to the listing of counties with a loftier incidence of TB (PDF) where utilize of the questionnaire is recommended prior to entering schoolhouse. As resources allow, school districts in other counties may use the TB questionnaire to identify children who should receive a TB skin examination prior to schoolhouse entry.

Children who have a positive reaction to the TB skin test only no symptoms of TB disease should NOT be kept out of schoolhouse while they are being evaluated for treatment of TB infection.

The American University of Pediatrics (AAP) recommends that physicians routinely assess a child's risk of TB exposure with a questionnaire and offering tuberculin pare testing only to at-take chances children. The AAP does not recommend routine tuberculin skin testing of children with no TB risk factors for school entry, day care attendance, WIC eligibility, or military camp omnipresence.

A tuberculin skin test may be applied on the aforementioned mean solar day as routine immunizations. The pare test will need to exist read 48-72 hours later. If a skin test is not placed on or before the solar day of a live virus immunization such as measles-mumps-rubella (MMR), then the skin test should exist postponed at to the lowest degree half dozen weeks.

For more than data near TB screening for children in schoolhouse settings visit the following links:

Recommendations for TB Screening of School Aged Children (PDF)
Tuberculosis Questionnaire in English (DOC)
Tuberculosis Questionnaire (en Español) (Dr.)

For Correctional Settings

Are correctional facilities in Texas required to screen inmates and employees for TB?

The law (Affiliate 89 of the Texas Wellness & Condom Code) in Texas requires county correctional facilities that meet whatsoever one of three criteria to screen all inmates for TB by the 7th day of incarceration and annually thereafter, and to screen all employees and volunteers both pre-employment and annually thereafter.

The three criteria are equally follows:

a capacity of 100 or more beds,
housing inmates transferred from a county that has a jail with a capacity of 100 or more beds, or
housing inmates from some other state.

The constabulary also requires all correctional facilities in the country, including youth detention facilities, regardless of whether they meet the criteria stated above, to report to the Texas Section of State Wellness Services, Communicable diseases Intervention and Command Branch, the release of inmates being treated for TB and so that the Section tin conform for continuity of care.

Other Resources

What are other recommended sites where I tin can detect information about tuberculosis?

Centers for Disease Control and Prevention:

Bones TB Facts
Tuberculosis Fact Canvass
Tuberculosis Fact Sheet (PDF) Courtesy of the CDC

HIPAA:

Ofttimes asked questions almost HIPAA Privacy Rule

Medical Consultation:

TB Medical Consultation Process

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Source: https://www.dshs.texas.gov/disease/tb/faq.shtm