POD PreCheck: Online Screening Tool

Anthrax Screening Form

Form Instructions

Select the anthrax screening form link above to complete the screening form. PRINT the completed form(s), and bring it to the POD site.

The information provided will help us:

• Determine whether it is safe to give a medicine,
• Determine the best type and amount of medicine, or
• Refer to a health care provider, if needed.

Please answer all questions.

Health Information Privacy Notice (Tennessen Notice)

POD staff and/or medical consultants may have access to the information you provide. The Minnesota Department of Health (MDH), tribal public health departments, local public health departments, and the United States Department of Health and Human Services, which includes the Centers for Disease Control and Prevention (CDC), may also have access to this information. Your private health information will not be provided to anyone else without your consent.

You are not under legal obligation to provide your private information to us. However, without it, you may not receive the best medicine for you.