Chest Clinic - Request for TB Screening

If a local General Practitioner (GP) or Staff Health has referred you to Liverpool Chest Clinic for further TB screening, please fill in this form and click on the Submit key at the bottom of the form.

Liverpool Chest Clinic (LCC) will only accept referrals from clients residing in the South West Sydney Local Health District (SWSLHD) area. Clients who live outside of the SWSLHD catchment area can be referred to their local chest clinic chest-clinics

Resources

Information on IGRA (QuantiFERON- TB Gold Plus) blood test can be found in interferon-gamma-release-assay-test

Information on Tuberculin Skin Test (TST) or Mantoux Test can be found in tst-factsheet

Health Care Worker

If you are a health care worker, your staff health team or local GP will organise the initial TB screening for you. This will include an IGRA blood test. Your local GP or Staff Health will refer you to Liverpool Chest Clinic if you have a positive IGRA blood test, symptoms of TB or an abnormal chest x-ray. They may also refer you if you have not had a prior BCG vaccination, if you need a Mantoux test (also known as a tuberculin skin test) or have had 2 repeat IGRA results return indeterminate.

Health Care Student

Please refer to Information on TB screening of Health Care Students for more information on health care students TB screening.

For health care students, please see your local GP for your initial TB screening. This will include an IGRA blood test.

Your local GP or Compliance Hub will refer you to Liverpool Chest Clinic if you have a positive IGRA blood test, symptoms of TB or an abnormal chest x-ray. They may also refer you if have had 2 repeat IGRA results return indeterminate.

Information on 'TB high risk countries' can be found in https://www.health.nsw.gov.au/Infectious/tuberculosis/Pages/high-incidence-countries.aspx

The TB Assessment tool document can be found in TB assessment tool

Other Groups

Other groups referred by local GP for TB screening such as missionaries, staff working in morgues, people working with wildlife (in zoos) and overseas exchange students may also submit this form. Please bring your GP referral letter with you on the day of your appointment at the chest clinic to avoid delay.

Personal Details

* (at least one is required)
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(e.g. missionary, people working with wildlife in zoos, overseas exchange students, etc etc)

Your General Practitioner's (GP's) Details - if available:

TB screening history:

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If all your visits to any single country add up to more than three months answer yes.
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Reload
Please type what you see:

If you require any other information please call 02 8738 4888


between 09:00am to 12:00pm and 2:00pm to 4:00pm, Monday to Friday.

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Page last updated: 30 August, 2019