{ "document_id": 14113, "page": 1, "width_pt": 612, "height_pt": 792, "rotation": 0, "pipeline_version": "paddleocr-vl-1.6+paul-48", "engine": "paddleocr_vl", "source_run_id": 14223, "item_count": 49, "counts_by_type": { "figure": 2, "footer": 1, "form_field": 20, "header": 4, "heading": 2, "text": 19, "title": 1 }, "build_ms": 9, "items": [ { "id": "p1.1", "order": 1, "type": "figure", "bbox": { "l": 28.8, "t": 747.84, "r": 119.28, "b": 698.16 }, "text": "", "attrs": { "role": "page_header", "block_label": "header_image" } }, { "id": "p1.2", "order": 2, "type": "header", "bbox": { "l": 125.04, "t": 740.88, "r": 399.12, "b": 717.12 }, "text": "KENTUCKY STATE UNIVERSITY", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p1.3", "order": 3, "type": "header", "bbox": { "l": 226.32, "t": 705.12, "r": 332.88, "b": 689.28 }, "text": "School of Nursing", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p1.4", "order": 4, "type": "header", "bbox": { "l": 461.52, "t": 738.96, "r": 579.12, "b": 717.12 }, "text": "400 EAST MAIN STREET\nFRANKFORT, KENTUCKY 40601", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p1.5", "order": 5, "type": "header", "bbox": { "l": 470.88, "t": 703.2, "r": 574.56, "b": 668.64 }, "text": "PHONE: (502) 597-5957\nFAX: (502) 597-5818\nwww.kysu.edu", "attrs": { "block_label": "header" }, "level": 2 }, { "id": "p1.6", "order": 6, "type": "figure", "bbox": { "l": 24.75, "t": 756.75, "r": 584.25, "b": 691.5 }, "text": "", "attrs": { "source": "pdf_image" } }, { "id": "p1.7", "order": 7, "type": "title", "bbox": { "l": 158.64, "t": 630.96, "r": 453.12, "b": 613.44 }, "text": "Record of Tuberculosis Screening: Two Step", "attrs": { "block_label": "doc_title" }, "level": 2 }, { "id": "p1.8", "order": 8, "type": "text", "bbox": { "l": 69.12, "t": 578.64, "r": 538.8, "b": 564.24 }, "text": "Student Name: ___ DOB: ___", "children": [ { "id": "p1.8.1", "order": 9, "type": "form_field", "bbox": { "l": 159.12, "t": 586.32, "r": 354.6, "b": 566.64 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Student Name", "source": "acroform", "label": "Student Name: ___ DOB: ___", "label_source": "parent_text", "label_ref": "p1.8", "text_offset": 14, "text_span": 3 } }, { "id": "p1.8.2", "order": 10, "type": "form_field", "bbox": { "l": 392.64, "t": 586.32, "r": 536.52, "b": 566.64 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "DOB", "source": "acroform", "label": "Student Name: ___ DOB: ___", "label_source": "parent_text", "label_ref": "p1.8", "text_offset": 23, "text_span": 3 } } ] }, { "id": "p1.9", "order": 11, "type": "text", "bbox": { "l": 306.48, "t": 563.28, "r": 545.52, "b": 494.88 }, "text": "
\"Image\"
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Results must be recorded in millimeters. Positive, negative or +/- are not acceptable. Results must be read in 48-72 hours." }, { "id": "p1.15", "order": 20, "type": "heading", "bbox": { "l": 69.36, "t": 408.72, "r": 111.6, "b": 394.32 }, "text": "Step 1:", "attrs": { "block_label": "paragraph_title" }, "level": 3 }, { "id": "p1.16", "order": 21, "type": "text", "bbox": { "l": 68.64, "t": 385.44, "r": 539.04, "b": 371.04 }, "text": "Date/Time Administered: ___ Administered by: ___", "children": [ { "id": "p1.16.1", "order": 22, "type": "form_field", "bbox": { "l": 213.24, "t": 393.36, "r": 328.32, "b": 373.68 }, "text": "", "attrs": { "field_kind": "text", "label": "Date/Time Administered: ___ Administered by: ___", "pdf_field_name": "DateTime Administered", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.16", "text_offset": 24, "text_span": 3 } }, { "id": "p1.16.2", "order": 23, "type": "form_field", "bbox": { "l": 428.4, "t": 393.36, "r": 537.84, "b": 373.68 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Administered by", 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152.28, "t": 350.88, "r": 267.36, "b": 331.2 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Results in mm", "source": "acroform" } }, { "id": "p1.20", "order": 28, "type": "text", "bbox": { "l": 452.88, "t": 343.68, "r": 520.8, "b": 327.6 }, "text": "Positive", "children": [ { "id": "p1.20.1", "order": 29, "type": "form_field", "bbox": { "l": 453.96, "t": 342.72, "r": 471.48, "b": 327.72 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Positive", "source": "acroform", "label": "Positive", "label_source": "parent_text", "label_ref": "p1.20", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p1.21", "order": 30, "type": "form_field", "bbox": { "l": 354.48, "t": 344.04, "r": 372, "b": 329.16 }, "text": "", "attrs": { "field_kind": "checkbox", "pdf_field_name": "Negative", "source": "acroform" } }, { "id": "p1.22", "order": 31, "type": "text", "bbox": { "l": 69.36, "t": 290.88, "r": 233.52, "b": 276.48 }, "text": "Step 2: (repeat in 1-3 weeks):" 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538.08, "b": 232.32 }, "text": "Date/Time TST read: ___", "children": [ { "id": "p1.24.1", "order": 36, "type": "form_field", "bbox": { "l": 185.28, "t": 254.28, "r": 311.76, "b": 234.6 }, "text": "", "attrs": { "field_kind": "text", "label": "Date/Time TST read: ___", "pdf_field_name": "DateTime TST read_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.24", "text_offset": 20, "text_span": 3 } } ] }, { "id": "p1.25", "order": 37, "type": "heading", "bbox": { "l": 313.44, "t": 246.48, "r": 367.68, "b": 232.32 }, "text": "Read by:", "children": [ { "id": "p1.25.1", "order": 38, "type": "form_field", "bbox": { "l": 368.64, "t": 254.28, "r": 535.68, "b": 234.6 }, "text": "", "attrs": { "field_kind": "text", "label": "Read by:", "pdf_field_name": "Read by_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.25", "text_offset": 8, "text_span": 0 } } ], "level": 3 }, { "id": "p1.26", "order": 39, "type": "text", "bbox": { "l": 70.56, "t": 226.08, "r": 438.24, "b": 210.72 }, "text": "Results in mm: ___ Interpretation: □ Negative\n□ Positive", "children": [ { "id": "p1.26.1", "order": 40, "type": "form_field", "bbox": { "l": 152.28, "t": 233.16, "r": 273.12, "b": 213.48 }, "text": "", "attrs": { "field_kind": "text", "label": "Results in mm", "pdf_field_name": "Results in mm_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.26", "text_offset": 15, "text_span": 3 } }, { "id": "p1.26.2", "order": 41, "type": "form_field", "bbox": { "l": 357.96, "t": 226.44, "r": 375.48, "b": 211.44 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "Negative", "pdf_field_name": "Negative_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.26", "text_offset": 35, "text_span": 1 } } ] }, { "id": "p1.27", "order": 42, "type": "text", "bbox": { "l": 453.84, "t": 226.8, "r": 523.2, "b": 210.24 }, "text": "Positive", "children": [ { "id": "p1.27.1", "order": 43, "type": "form_field", "bbox": { "l": 455.04, "t": 225.84, "r": 472.44, "b": 210.96 }, "text": "", "attrs": { "field_kind": "checkbox", "label": "Positive", "pdf_field_name": "Positive_2", "source": "acroform", "label_source": "parent_text", "label_ref": "p1.27", "text_offset": 0, "text_span": 0 } } ] }, { "id": "p1.28", "order": 44, "type": "text", "bbox": { "l": 69.6, "t": 182.88, "r": 513.6, "b": 154.56 }, "text": "QuantiFERON Gold testing (recommended if immunized with BCG or a previous positive TST test):" }, { "id": "p1.29", "order": 45, "type": "text", "bbox": { "l": 69.84, "t": 141.36, "r": 210.96, "b": 127.44 }, "text": "Results: ___ *", "children": [ { "id": "p1.29.1", "order": 46, "type": "form_field", "bbox": { "l": 114.84, "t": 148.56, "r": 201.24, "b": 128.88 }, "text": "", "attrs": { "field_kind": "text", "pdf_field_name": "Results", "source": "acroform", "label": "Results: ___ *", "label_source": "parent_text", "label_ref": "p1.29", "text_offset": 9, "text_span": 3 } } ] }, { "id": "p1.30", "order": 47, "type": "text", "bbox": { "l": 69.6, "t": 112.56, "r": 365.04, "b": 98.4 }, "text": "[p1.30.1]A copy of lab result must be included with this form.", "children": [ { "id": "p1.30.1", "order": 48, "type": "text", "bbox": { "l": 69.6, "t": 112.56, "r": 365.04, "b": 98.4 }, "text": "^{*}", "attrs": { "inline": true, "text_offset": 0, "text_span": 9, "bbox_estimated": true } } ] }, { "id": "p1.31", "order": 49, "type": "footer", "bbox": { "l": 456.96, "t": 46.8, "r": 540.96, "b": 35.76 }, "text": "FormSONTB:062018", "attrs": { "block_label": "footer" } } ], "excluded_furniture": { "first": [], "last": [] } }