Tuberculosis Skin Response
Skin Test
Skin Response Category
Skin Response Test Performed?
No
Yes
What was the reason the test was not done?
Intervention Performed
What was the date of the intervention performed to elicit the skin response?
01 Jan 2000
What was the time of the intervention performed to elicit the skin response?
12:00
What was the date of the skin response measurement?
01 Jan 2000
What was the time of the skin response measurement?
12:00
Anatomical Location
Arm
Leg
Side
Right
Left
Directionality
Upper
Lower
Anterior
Skin Response Test Name
Choose
Flare Size
Flare Mean Diameter
Induration Longest Diameter
Wheal Size
Wheal Longest Diameter
Wheal Mean Diameter
Result
What was the unit of the skin response measurement?
mm
cm
Who was the evaluator?
Investigator
Health Care Professional
Study Subject
*
Mandatory field