Credential Programs

TB Risk Assessment Guide

A licensed healthcare provider must complete a TB Risk Assessment for credential program applicants. Clearance is required for admission to the credential program.

Step 1: Make an Appointment

  • Schedule an appointment with your healthcare provider or find a walk-in clinic or urgent care.
  • If you have a Fresno State Student ID Number, you can schedule an appointment with the Fresno State Health Center: 559.278.2734.
  • If you are uninsured, the Fresno EOC has low to no cost healthcare options.
  • If you work for a school district, school nurses can sign off on your form as long as you do not have a documented history of TB and you are not showing symptoms. 

Step 2: Print Your Form

  • Print out your TB Risk Assessment form to take with you to your appointment. Leave it blank.
    TB Risk Assessment Form

Step 3: Appointment Day

  • Bring your blank form to your appointment. 
  • You may be asked questions about your symptoms, given a TB test, and/or given a chest x-ray at your appointment.
  • Your healthcare provider will fill out the form and return it to you.
  • If you went to the Fresno State Health Center, a clearance memo will be available for download on your MyBulldogHealth portal.

Step 4: Double-Check Your Form

After your appointment, please be sure to double-check that your healthcare provider has filled out your form correctly and in its entirety. 

Step 4A.

  • On Page 1, your healthcare provider should fill in the following:
    • Your First and Last Name
    • The Assessment Date
    • Your Date of Birth
    • Under History of Tuberculosis Disease or Infection, they will need to mark Yes or No.
    • Under TB testing is recommended, they will need to mark any of the options that apply to you. If none apply to you, this section can be left blank.

TB form Page 1

Step 4B.

  • On Page 4, your healthcare provider should fill in the following:
    • Your First and Last Name
    • Your Date of Birth
    • The Assessment Date
    • The Healthcare Provider's Signature
    • The Healthcare Provider's Address Stamp. This can also be a label or it can be written in.


TB Form Page 4

Step 4C. 

  • If your healthcare provider marked No on Page 1, any licensed healthcare provider can sign Page 4.
  • Please Note: We do not accept signatures from counselors.

TB Form with No marked

Step 4D.

  • If your healthcare provider marked Yes on Page 1, only a physician, physician assistant, or nurse practitioner can sign Page 4.

TB form with Yes marked

Step 4E.

Fresno State Health Center Patients

  • If you went to the Fresno State Health Center, you will be provided with a memo that is available for download on your MyBulldogHealth portal under Letters.
    MyBulldogHealth
    Location of TB Memo under Letters
  • Please check this for accuracy to make sure the following are listed:
    • Your First and Last Name
    • The Assessment Date
    • The Healthcare Provider's Name

TB Memo Example

Step 5: Program Application Attachment

  • Attach your approved TB Risk Assessment form or Fresno State memo to the Program Application.
  • The form and memo are valid for 4 years.
  • Please Note: We will not accept any documents that are different from the ones mentioned on this page.

TB Risk Assessment Troubleshooting

  • If you encounter any errors on your form, you will need to contact the healthcare provider who filled it out for you.
  • For Fresno State Health Center Patients: If you cannot locate your memo on MyBulldogHealth, please call 559.278.2734.