Positive Tuberculin Skin Test (TST) and Interferon-Gamma Release Assay (IGRA) Reporting Form

Personal information on this form is collected under the authority of the Health Protection and Promotion Act R.S.O 1990, c. H.7, s.26; R.R.O. 1990, Reg. 569, s.1 (2), amended and in accordance with PHIPA and will be used for assessment, mangement, treatment and reporting purposes. Questions about this collection should be addressed to the Medical Officer of Health at KFL&A Public Health, 221 Portsmouth Avenue, Kingston, ON K7M 1V5 613-549-1232 or 1-800-267-7875.

If you feel your patient may have active TB, please call 613-549-1232 immediately.

Reporting source

Patient Information

Tests

Please measure induration only, parallel to the watch band.

If a TST or IGRA is positive, order a chest x-ray and upload a copy of the result. If patient is asymptomatic, a chest x-ray within the last 12 months may be used. Please do not submit report until CXR result is attached.

If your patient has had a cough lasting longer than 2 weeks, collect 3 sputum samples, taken at least 1 hour apart, and submit for microscopy and culture. Upload a copy of the results

Alternatively, lab results (IGRA, CXR, sputum) may be faxed to 613-549-0349

TB - like symptoms (include onset date) 

Other risk factors