DHEC TB Form.pdf

This document is a South Carolina Department of Health and Environmental Control (DHEC) form titled "School Employee/Individual Certificate of Evaluation for Tuberculosis." The form is used to document tuberculosis screening results for school employees and individuals working in public or private schools, kindergartens, nurseries, or day care centers in South Carolina, as required by the Code of Laws of South Carolina, 1976, as amended April 24, 1979.

The form includes sections for recording tuberculin skin test results using the Mantoux method (5 TU PPD), chest X-ray results, and disposition status including options for no infection, infection without disease, preventive treatment status, history of tuberculosis, current tuberculosis disease, and non-contagious status. The form requires a physician's signature and must be retained in the files of the current employer or individual following evaluation and certification. The document shown is form DHEC 1420 (08/1998) and appears as two identical forms per page, likely for duplicate record-keeping purposes.