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Date
Please check The box if you are currently experiencing any of the following symptoms or risk factors.
Risk factors within the last year High
Medium
Low

Medical risks: Diabetes mellitus, smoker within past one year, leukemia, lymphoma, silicsis, Cancer of head or neck, intestinal bypass?gastrectomy, chronic malabsorption,  body mass index < 20 


High TB prevalence country: Africa, Asia Pacific, Eastern Europe incl. Russia, Latin America incl. Mexico. 


Interferon Gamma Release Assay is preferred over Tuberculin Skin Test for foreign-born persons. 


TB Risk Questionnaire

Personal Items

All resident’s personal items should go directly to the SMCF Laundry Department to be clearly labeled with their name upon admission.  Clothing will be marked in an inconspicuous place.  Unmarked items make it impossible to identify ownership and proper labeling will assure that your family member’s items remain safe with them.  Personal television sets are allowed and are properly set up by our Maintenance Department.

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