Ammon Medical and Urgent Care Terry N. Amiel, M.D. 3456 E. 17" Street Suite 125 Idaho Falls, Idaho 83406 (208) 529-2828 TUBERCULIN MANTOUX TEST RECORD NAME_Rachel C' oyd, ze DATE GIVEN_3-3-1 4 pop. 4ea4R 0 ye sR my Instructions: Observe the skin where the test was administered between 48 and 72 he! (2t0 3 days) after testing. If the area is without redness of swelling, this indicates the test is negative, Ifthe site is visibly red, swollen or irritated, further evaluation including a chest x-ray must be obtained for confirmation. The site must be evaluated in by a nurse so that appropriate documentation is obtained. If you have any questions concerning this test or the results, please do not hesitate to contact our office 72 hour: Thank you! Positive EEative) Chest X-Ray essen ered