TB Skin Test - Valley Hospital
TB Skin Test - Valley Hospital
TB Skin Test - Valley Hospital
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IF YOUR DOCTOR RECEIVES A NOTICE THAT HIS/HER PPD HAS EXPIRED, PLEASE ADVISE<br />
YOUR DOCTOR AS STATED BELOW:<br />
PPD reminder notice<br />
This is just a reminder that your Tuberculosis <strong>Skin</strong> <strong>Test</strong> (PPD) has expired. The State of New Jersey<br />
has mandated that all physicians and allied health professionals must participate in a <strong>TB</strong> surveillance<br />
program. All providers with a negative PPD must take the skin test annually.<br />
The Medical Board has mandated that any practitioner not complying with this New Jersey State<br />
requirement can have their clinical privileges suspended. Please submit your PPD result as soon as<br />
possible, in order to minimize any disruption to your patients’ care. For your convenience, I have<br />
attached a form for you to use.<br />
WHERE TO GET YOUR <strong>TB</strong> SKIN TEST<br />
1. You may obtain your current PPD in any facility of your choice.<br />
2. PPD is offered at the Employee Health Service in the Kraft Center in Paramus, Monday through<br />
Friday, 8:00 am – 4:30 pm. Please call 201-291-6430 for an appointment.<br />
3. PPD is offered at the Employee Health Service in the hospital’s Emergency Department on<br />
Wednesday mornings, from 7 am to 10 am.<br />
WHERE TO SUBMIT YOUR DOCUMENTATION<br />
Mail, fax, or bring in your results to Eileen Fiengo in the hospital’s Medical Staff<br />
Administration office, 223 N. Van Dien Ave., Ridgewood, NJ 07450. Fax to (201) 447-8491.<br />
Call 201-447-8020 with any questions.<br />
Thank You<br />
John Preolo, CPMSM<br />
Manager<br />
Medical Staff Administration
To: , <<br />
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first_name> , <br />
Annual Medical Staff<br />
Tuberculin <strong>Skin</strong> <strong>Test</strong> Record<br />
Physician Name: ________________________________<br />
Administered on this date: _____________<br />
Manufacturer and Lot #:______________________<br />
Signature of Person Administering <strong>Test</strong>: ________________<br />
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*Read test within 48-72 hours of placing the test*<br />
Date PPD Read:__________________________________________<br />
Measure the reaction in millimeters: Results:____mm:_____<br />
Signature of person reading the test: _________________________<br />
WHERE TO SEND THIS COMPLETED DOCUMENT<br />
T<br />
The <strong>Valley</strong> <strong>Hospital</strong>, Medical Staff Administration Office<br />
Attention - Eileen Fiengo<br />
S 223 North Van Dien Avenue, Ridgewood, NJ 07450<br />
T Fax # 201-251-3387 / Phone # 201-447-8020
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