Civil Surgeon Tuberculosis Screening Medical Examination for All Applicants 2 Years of Age or Older

Top of chart begins: “Civil surgeon (CS) conducts a medical history, physical examination, and IGRA test on applicant*”

1. If “IGRA Negative”, then “No Class A or Class B TB”
2. If “IGRA Positive”, then “Chest x-ray”
   1. If “Chest x-ray Negative”, then “B2, Latent TB Infection”, then “Required LTBI report to health department*”
   2. If “Chest x-ray Positive”, then “Referred to health department for sputum smears and cultures”
3. 1. 1. If “Negative Cultures”, then “Applicant returns to CS Class B1, Pulmonary TB”
      2. If “Positive Cultures”, then “Class A TB Disease Applicant must complete treatment”, then “Applicant returns to CS after treatment. CS reclassifies as Class B0, Pulmonary TB”
4. If “Signs or symptoms of TB or known HIV infection”, then “Chest x-ray”, then “Referred to health department for sputum smears and cultures”
   1. If “Negative Cultures”, then “Applicant returns to CS Class B1, Pulmonary TB”
   2. If “Positive Cultures”, then “Class A TB Disease Applicant must complete treatment”, then “Applicant returns to CS after treatment. CS reclassifies as Class B0, Pulmonary TB”

* Interferon gamma release assay (IGRA), Latent tuberculosis infection (LTBI)