Attachment 1: Performance Work Statement Appendix 3

Negative/normal film:

EXAM: X-RAY OF THE CHEST

CLINICAL DATA: Evaluate for TB.
TECHNIQUE : Single PA view of the chest.
PRIOR STUDIES: No prior studies submitted.
FINDINGS: No radiographic evidence of TB. The trachea is midline. The heart size is within normal limits. No infiltrate, effusion or pneumothorax. The soft tissues and bony structures demonstrate no acute pathology. No evidence of atherosclerotic disease of the aorta. No acute osseous abnormality is detected.
IMPRESSION: Negative screening for Active TB disease by radiographic criteria: normal CXR. Requires nurse review; Clear for general population.

Abnormal film:
Findings vary according to abnormality(ies) found.
Impression: POSITIVE screening for Active TB disease by radiographic criteria: pulmonary parenchymal and/or pleural finding(s) and/or mediastinal lymphadenopathy, cannot exclude Active TB; findings as noted above. A provider should apply IHSC TB Clinical Guideline screening algorithm (Category A, B or C) for further action, if necessary.