Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Name:................................................................. Centre:...............................................................
Age:.................................................................... Date:...................................................................
Date of Birth:.....................................................
Sex: M/F............................................................ Score established by:.........................................
Weight:..............................................................
BCG scar:...........................................................
SCORE A (circle the corresponding box and write the score in the column)
0 1 3 Score
Duration of the less than 2 weeks 24 weeks more than 4 weeks
disease
Nutritional status > 80% of weight for between 70 and 80% less than 70%
height
Family contact with none reported by family contact with
TB patient confirmed M+
subject
Total (1) =
Total 1 + 2 = _______________