div class=trans-pagebuttonPage 1button div class=trans-image amp-img class=trans-thumb alt=Page 1: LIC 701 198 Confidential have Physician: Address Risk factors present Mantoux TB skin test performed unless previous positive skin test documented Communicable TB disease src=https:reader033fdocumentsusreader033viewer20220420015e6da74c36961544a82f93fdhtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdiv