The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

iegdVMEoZb8APL6tiPreXUzJResV9UH9NPH2Fth7wTtyn3cLcbwkzYUwUpNQ6TBNPEG8Xbv

Incoming Vanderbilt student TB assessment form

Returning?

A A A

Welcome to Vanderbilt University! This tuberculosis (TB) screening survey is required of all incoming students and allows the Student Health team to determine who may need TB testing before arriving on campus based on your risk factors and program type. Answer the questions below and follow prompts to submit answers and download a Testing form for current year testing or a form showing your answers that No Testing is needed.

Last name (family name)

* must provide value

First name

* must provide value

Date of birth

* must provide value

M-D-Y

Email address

* must provide value

Phone number (in the United States)

Are you entering the School of Nursing?

* must provide value

Yes No

reset

Submit your answers to our data base.

Download and print the School of Nursing Tb Testing Form and take it to your healthcare provider or retail lab for completion. TB blood testing must be performed within 3 months of start of program.

Fall students- TB blood testing must be on/after May 1st of current year.
Spring students- TB blood testing must be on/after October 1st of current year.

After the TB testing is completed and the form signed by your provider, upload the form AND the lab report to the Student Health Portal along with your immunization records. Note you will need to upload these same documents to the VUSN compliance portal

Attachment:Nursing Students Tb-Fall 2024.pdf

Are you entering the School of Medicine?

* must provide value

Yes No

reset

Which program are you entering?

* must provide value

Please download the Tb Assessment document that is required for all School of Medicine programs. You should print this document and take to your healthcare provider for completion. This document should be uploaded to the Student Health portal along with your immunization documents.

Attachment:VUSM Students Tb-2024.pdf

Have you ever had a TB skin test or a TB blood test?

* must provide value

Yes No

reset

Have you ever been told that your skin test or blood test for TB was "positive" or "abnormal"?

* must provide value

Yes No

reset

Are ANY of the following statements true:
1. I've had a known Tb exposure within the last year
2. I had the BCG (tuberculosis) vaccine as a child
3. I have a suppressed immune system from medications/chemotherapy or from an underlying chronic condition
4. I have worked or volunteered in a prison, homeless shelter, nursing home or hospital (currently or in the past)

* must provide value

Yes No

reset

Review the attached list of countries designated by the World Health Organization with a high risk of tuberculosis.

Attachment:Tb incidence 20 per 100,000 updated spring 2024.pdf

Were you born in one of the high risk countries -or- spent more than 6 weeks in one of the high risk countries?

* must provide value

Yes No

reset

Result: Based on your responses above, you do not need a Tb skin test or blood test at this time.
DO NOT CLOSE THE SURVEY ......... FOLLOW THESE NEXT STEPS:

Click SUBMIT to send your responses to our internal TB database.
SAVE this PDF (You will see the PDF download link after clicking SUBMIT).
Log into the Student Health Portal and upload with your immunization form.

Based on your responses above, you will need screening for tuberculosis. This is required for registration.

Your physician must fill out this Tb testing form for you. Download and print this form.
When Tb testing is completed, have your provider complete the form and give you a lab report. Submit both to the Student Health Portal with your immunization records.

Attachment:Tuberculosis (Tb) testing form-2024.pdf

Based on your responses to this on-line screening form, we will need additional information from you.

Please print the attached document below. Your physician must fill out more information about your Tb history. After your healthcare provider completes this form, you must include it with your Vanderbilt health questionnaire or other official immunization documents that are submitted to the university on the incoming student portal.

If you do not submit this Tb form with your immunization records, it will delay the processing of your file.

Attachment:History of positive TB test 2024.pdf

You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.