Rebuilt HTML — PaddleOCR-VL (Baidu)
Semantic HTML reconstructed from the OCR item tree (headings, text, lists, tables, form fields). overlay · view JSON
Record of Tuberculosis Screening: Two Step
Student Name: ___ DOB: ___
<div style="text-align: center;"><img src="imgs/img_in_image_box_4_26_1028_296.jpg" alt="Image" width="99%" /></div>
Type of Screening (check one):
Tuberculin Skin Test (TST) IGRA
IGRA
TST testing: If initial testing for tuberculosis, student must have a two-step TST once. Results must be recorded in millimeters. Positive, negative or +/- are not acceptable. Results must be read in 48-72 hours.
Step 1:
Date/Time Administered: ___ Administered by: ___
Results in mm: ___ Interpretation: ☐ Negative
Step 2: (repeat in 1-3 weeks):
Date/Time Administered: ___ Administered by: ___
Date/Time TST read: ___
Results in mm: ___ Interpretation: ☐ Negative □ Positive
Results: ___ *
*A copy of lab result must be included with this form.