RMP TB Screen

TB Screen for Prehire Candidate [text name="name"]  

[select name="tbt" value="Quantiferon|T-spot|PPD"]: [select name="TB_test" value="negative|positive|indeterminate"]
CXR: [select name="cxr" value="negative|positive|indeterminate"]   [text name="cxr_findings"]
TBQ: [select name="tbq" value="symptomatic|asymptomatic|high risk country"]
Decision: [select name="cleared" value="cleared, no evidence of tuberculosis disease (aka Active TB)|not cleared, refer to pulmonary or health department "]

[textarea name="comments"]
TB Screen for Prehire Candidate


Result - Copy and paste this output:

Sandbox Metrics: Structured Data Index 0.63, 8 form elements, 8 boilerplate words, 2 text boxes, 1 text areas, 5 drop downs, 8 total clicks
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