DELAWARE MODERN
PEDIATRICS, P.A.
David M. Epstein, M.D.
300 Biddle Avenue, Suite
206
Springside Plaza, Connor
Building
Newark, Delaware 19702
Phone: (302) 392-2077
Fax: (302) 392 - 0020
www.DelawareModernPediatrics.com
Dear School Nurse,
The student named below had a PPD placed on the left
forearm in our office.
Student Name:
Date PPD
planted:
As you know, the PPD must be read 48 to
72 hours after it is planted. May we
ask you, please, to read the student’s PPD, record the number of millimeters of
induration, and fax the result back to our office?
Our fax number is (302) 392 -0020. Thank you for your help!
Date PPD read:
# mm induration:
School nurse’s name:
Nurse’s Signature: