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PPD Placement
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Reason for PPD testing
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Does the patient have a documented previous positive TB test?
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Has the patient had a severe reaction to a previous TB skin test?
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TB symptoms reported today
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Recent close contact with a person with infectious TB
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BCG vaccination history
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TB risk factors
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PPD product/manufacturer
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PPD Lot Number
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PPD expiration date
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Dose administered
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Other Dose Size:
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Route
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Other Route:
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Administration site
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Other Administration Site:
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Initial wheal size in mm
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Was PPD placement valid?
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Reason placement was invalid
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Specify Other reason for invalid PPD:
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Placement Details/Instructions
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Patient instructed to return within 48–72 hours
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Additional placement details
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