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Get Form 2054

054 form) DS-2054 08-2011 Page 1 of 3 Class B Tuberculosis - Continued Class B3 TB, Contact Evaluation TST mm IGRA negative IGRA positive IGRA Result No preventive treatment Current preventive treatment (Indicate medications in Part 4 of DS-2054 form) Completed preventive treatment (Indicate medications in Part 4 of DS-2054 form) Source Case: Name Alien Number Relationship to Contact Date Contact Ended (mm-dd-yyyy) Type of Source Case TB (Mark only one and ATTACH DST RESULTS) Pansusce.

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