Form H is Hawaii's department-approved screen for signs and symptoms of TB disease under HAR 11-164.2. It asks how long the person has been coughing, whether they have coughed up blood, and about unexplained fevers above 100 F, night sweats, weight change and fatigue over the past year, and it feeds the clearance decision recorded on Form F.
Medical staff review the screen and record the assessment date. The patient answers the questions, or another person provides the information and is named with their relationship.
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State of Hawaii TB Symptom Screen (TB Document H)
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No. Form H states that it is not a TB clearance, and the DOH TB Clearance Manual says negative tests, Form H and Form G alone do not confer clearance. A licensed MD, DO, APRN, NP or PA must review the results and issue TB Document F.
People screened for school, child care, food handler or health care facility clearance, and especially those with a documented previous positive TB test. For them, a negative symptom screen plus a recent chest X-ray that excludes TB, or a negative annual screen for health care workers, supports clearance.