Rick Scott

Governor

Mission:
To protect, promote & improve the health
of all people in Florida through integrated
state, county & community efforts.

John H. Armstrong, MD, FACS

State Surgeon General & Secretary
Vision: To be the Healthiest State in the Nation

Dear Parents and Staff:

January 26, 2015

It has come to our attention that a person at Plant High School has tuberculosis (TB). The School District of Hillsborough
County and your school principal, Robert Nelson, are working closely with the Florida Department of Health in Hillsborough
County to protect your children and teachers. This letter is being sent to those students, teachers, and other school staff who
are strongly recommended for TB screening. The TB skin test (Mantoux/PPD) is the only skin test that meets the health
department standards.
We have identified students and staff that may have had long enough contact (exposure) with this person that TB testing is
recommended. The TB skin test shows if TB germs have infected a person. For your convenience, the Department of
Health-Hillsborough will give the TB skin tests, free, on Tuesday, February 17, 2015, at 9:00 AM at the school. The skin
test must be read or examined 2 days after it is given, so the Department of Health will read the TB skin tests on Thursday,
February 19, 2015, at 9:00 AM at the school. Attendance on both days is mandatory to complete the TB screening. The skin
test may be done by your own doctor. If you take your child or yourself to your doctor, please bring this letter and ask your
doctor to fax the skin test results to the Department of Health at 813-975-2014. The date of testing has been determined
based upon the exposure. Your health is important to us.
Your permission is needed for your son/daughter/self to have the skin test done at the school. PLEASE FILL OUT
AND SIGN THE PERMISSION SLIP BELOW, AND RETURN IT TO SCHOOL by Friday, February 13, 2015. Your child/you
will also need to have a photo ID card with them.
If you would like to receive more information, we have set up a Parent Assembly for TUESDAY, January 27, 2015 from 6:00
PM to 7:00 PM at the school to answer questions you have. The health department and school staff will be there. Or call our
health staff at the TB Center (813) 307-8047, to answer questions you have.
We also want you to know that we cannot test for TB if your child has recently had a live virus vaccine (i.e., Varicella, Flu mist,
MMR). Please know that TB is a treatable disease. The person with TB is under medical care and does not pose a health risk
to your childs health or you at this time.
Sincerely,
Doug A Holt, MD, Director
Student Name/Name _________________________________________________ D.O.B. ____________________
Last, First, Middle
Address _________________________________________, Zip__________ Phone _________________________
Grade/Class ______________________________
Please answer the following 3 questions about the person named above by circling Yes or No. A blank is a No.
1. Has your child/you ever had a positive reaction to a TB Skin Test, or BCG/TB vaccine?

Yes

No

If yes, name of clinic/physician _________________________________ Phone __________________________

2. Has your child/you been vaccinated with Flu Mist, MMR or Varicella in the last month?

Yes

No

3. Does your child/you have medication allergies?

Yes

No

List: ______________________________________________________________________
I hereby grant permission to the Florida Department of Health-Hillsborough to give a TB skin test to the person named above.
This permission is good for 6 months following the date of signature.
Signature _____________________________________________________ Date __________________________
Parent/Guardian/Self
Florida Department of Health Hillsborough County
Division of Disease Control
P.O. Box 5135
Tampa, FL 33675-5135
PHONE: (813) 307-8047 FAX: (813) 975-2014

www.FloridasHealth.com
www.hillscountyhealth.org
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