Latent Tuberculosis Screening Questions
Tuberculosis is an infection which may remain in your body for years, without making you ill - this is called latent TB. The practice is trying to identify people who may have latent TB.
In which country were you born?
Have you lived in one of the below countries for at least 6 consecutive months in the last 5 years?
Please speak to a receptionist to book an appointment for a blood test.
Afghanistan, Angola, Bangladesh, Benin, Bhutan, Botswana, Burkina Faso, Burundi, Cambodia, Cameroon, Cape Verde, Central African Republic, Chad, China, Comoros, Congo, Cote D’lvoire, Djibouti, Dpr Korea, Dr Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Greenland, Guinea, Guinea-bissau, Haiti, Indonesia, India, Kenya Kiribati, Laos Pdr, Latvia, Lesotho, Liberia, Lithuania, Madagascar, Malawi, Mali, Marshall, Mauritania, Mauritius, Micronesia, Mongolia, Mozambique, Myanmar, Namibia, Nepal, Niger, Nigeria, Pakistan, Papua New Guinea, Peru, Philippines, Republic Of Moldova, Romania, Russian Federation, Rwanda, Sao Tome & Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sri Lanka, Swaziland, Tajikistan, Thailand, Timor-leste, Togo, Tuvalu, Uganda, Ur Tanzania, Uzabekistan, Vietnam, Zambia and Zimbabwe.
Anybody in England can register with a GP practice and receive free medical care from that practice.
However, if you are not ‘ordinarily resident’ in the UK you may have to pay for NHS treatment outside of the GP practice. Being ordinarily resident broadly means living lawfully in the UK on a properly settled basis for the time being. In most cases, nationals of countries outside the European Economic Area must also have the status of ‘indefinite leave to remain’ in the UK.
Some services, such as diagnostic tests of suspected infectious diseases and any treatment of those diseases are free of charge to all people, while some groups who are not ordinarily resident here are exempt from all treatment charges.
More information on ordinary residence, exemptions and paying for NHS services can be found in the Visitor and Migrant patient leaflet, available from your GP practice. Alternatively for more information go to
You may be asked to provide proof of entitlement in order to receive free NHS treatment outside of the GP practice, otherwise you may be charged for your treatment. Even if you have to pay for a service, you will always be provided with any immediately necessary or urgent treatment, regardless of advance payment.
The information you give on this form will be used to assist in identifying your chargeable status, and may be shared, including with NHS secondary care organisations (e.g. hospitals) and NHS Digital, for the purposes of validation, invoicing and cost recovery. You may be contacted on behalf of the NHS to confirm any details you have provided.
Please select one of the following statements:
I declare that the information I give on this form is correct and complete. I understand that if it is not correct, appropriate
action may be taken against me.
A parent/guardian should complete the form on behalf of a child under 16.
On behalf of:
Relationship to patient:
How will your EHIC/PRC/S1 data be used?
By using your EHIC or PRC for NHS treatment costs your EHIC or PRC data and GP appointment data will be shared with NHS secondary care (hospitals) and NHS Digital solely for the purposes of cost recovery. Your clinical data will not be shared in the cost recovery process.
Your EHIC, PRC or S1 information will be shared with The Department for Work and Pensions for the purpose of recovering your NHS costs from your home country.