If you indicate that you have any of the below conditions, or if you answered YES to any of the belowstatements, please explain below:
Changes in Medical Condition (check all that apply)
Since your last Health Screen Questionnaire:Have you had a positive reaction to PPD? If YES, did you or are you currently receiving prophylactic treatment?
Have you been diagnosed with Tuberculosis? If YES, were you treated?
Have you had a chest x-ray to test for Tuberculosis? If YES, was it positive?
(check any symptoms that you have had within the last year):
I certify that I have answered these questions honestly to the best of my knowledge.