Tuberculosis Screening

* Tuberculosis Screening

You were born or have lived for two months or longer outside of the United States.
You have had contact with someone who has tuberculosis.
You have had a previous tuberculosis test that had a positive result.
You have resided in, been employed by, or volunteered in the following high risk congregate settings: prisons and jails, nursing homes and other long-term facilities for the elderly, hospitals and other health care facilities, residential facilities for patients with acquired immunodeficiency syndrome (AIDS), and homeless shelters.

Have you ever traveled to/in one or more of the countries listed below?

If yes, please enter the name of the country/countries and the month and year you were there and how long you were in the country/countries listed.

 

None of the other choices apply to me.