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 with no signs or symptoms of TB and no known HIV infection”, then “No Class A or Class B TB”
2. If “IGRA Positive with no signs or symptoms of TB and no known HIV infection”, then “Chest x-ray”
   1. If “Chest x-ray not suggestive of infectious TB disease”, then “B2, Latent TB Infection”, then “Required LTBI report to health department”
   2. If “Chest x-ray suggestive of infectious TB disease”, then “Referred to health department for sputum specimens for smears and culture*”
      1. If “Negative Cultures”, then “Applicant returns to CS; Class B1, Pulmonary TB”
      2. If “Positive Cultures or clinical diagnosis of infectious TB disease”, then “Class A TB Disease Applicant must complete treatment”, then “Applicant returns to CS after treatment. CS reclassifies as Class B0, Pulmonary TB”
3. If “Signs or symptoms of TB or known HIV infection regardless of IGRA result”, then “Chest x-ray”, then “Referred to health department for sputum specimens for smears and culture”
   1. If “Negative Cultures”, then “Applicant returns to CS; Class B1, Pulmonary TB”
   2. If “Positive Cultures or clinical diagnosis of infectious TB disease”, then “Class A TB Disease Applicant must complete treatment”, then “Applicant returns to CS after treatment. CS reclassifies as Class B0, Pulmonary TB”

*Molecular testing of first specimen by health department is recommended, but not required.

Interferon gamma release assay (IGRA), Latent tuberculosis infection (LTBI), Human immunodeficiency virus (HIV)