TUBERCULOSIS SKIN TEST FORMHealthcare Professional/Patient Name: Training Location Date MM slash DD slash YYYY Site:RightLeftLous: Date MM slash DD slash YYYY RN MD Other Date Read (Within 48-72 hours from date placed) MM slash DD slash YYYY Induration (Please note in min) PPD (Mantoux) Test ResultNegativePositiveSignature (Administered by):Signature (Result Read / Reported by):