178 Columbia St, Chester, SC 29706
803-209-8667
info@larcareservices.com
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Tuberculosis (TB) Test Record
Location *
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Chester, South Carolina - 178 Columbia St.
Hopewell, Virginia - 2304 Freeman St.
SamariCare/Williamsburg - 710 Queensbury Lane
St. Thomas, Virgin Islands
Employee First Name *
Employee Last Name *
Email *
Contractor Type *
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Nurse
Aide
Admin or Operational
TB Test Date Completed
TB Test Result
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Positive
Negative
Chest X-Ray Date Completed
Chest X-Ray Result
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Positive
Negative
Upload a Copy of TB Test
Employee Name That Reviewed the TB Test — First
Employee Name That Reviewed the TB Test — Last
Reviewer Signature — type your full legal name to sign *
Date-Time Signed
Submit