DHEC TB Form.pdf

This is a South Carolina Department of Health and Environmental Control (DHEC) School Employee/Individual Certificate of Evaluation for Tuberculosis form (DHEC 1420). The form is designed to document tuberculosis screening results for school employees, including those working in public or private schools, kindergartens, nurseries, or day care centers. The document contains fields for recording both tuberculin skin test results using the Mantoux method and chest X-ray results, along with various disposition options including no infection, infection without disease, preventive treatment status, and history or current tuberculosis disease.

The form includes certification options for physicians to document their examination findings pursuant to the Code of Laws of South Carolina, 1976, as amended April 24, 1979. Notable administrative requirements include that the form must be retained in the files of the current employer or individual following evaluation and certification. The form appears designed to ensure compliance with state health regulations for school employment, with specific attention to tuberculosis screening and monitoring protocols.