Tuberculosis Questionnaire

Tuberculosis (TB) can be treated when detected early. While yearly screening is not necessary for everyone, screening tests can detect disease and allow for proper treatment. To help determine your child's risk please consider the following questions:

• Has a family member or contact had tuberculosis?
• Has a family member had a positive tuberculin skin test?
• Was your child born in a high-risk country (countries other than the US, Canada, Australia, New Zealand or Western and Northern European Countries)?
• Has your child traveled to a high-risk country (for > 3 months for Loudoun County or for > 1 month for Fairfax County)?
• How much contact did your child have with the resident population?
• VDH High Burden TB Country List
• Virginia Dept of Health TB Risk Assessment

Lead Questionnaire

• Live in or regular visit a home with peeling or chipping paint built before 1960?
• Live in or regular visit a home built before 1960 with recent or ongoing planned renovation?
• Have a sibling, housemate or playmate being followed for or treated for lead poisoning?
• Live with an adult whose job or hobby involves exposure to lead?
• Live near an active lead smelter, battery recycling plant or other industry likely to release lead?