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Sample · Illustrative only

Here's the document format your school or employer can review.

This is the format Practiclear documentation uses when documentation is appropriate after review. The version you receive, if issued, is generated with your reviewed result and signed by the provider on Practiclear letterhead — same layout, same fields, same NPI and license number you see below.

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Practiclear

Telehealth Lab Ordering · Virginia

practiclear.com

andrew@practiclear.com


April 30, 2026

Tuberculosis Screening — Documentation Letter

Patient
[Patient name]
Date of birth
[MM / DD / YYYY]
Test ordered
QuantiFERON-TB Gold Plus (IGRA)
Specimen drawn
Labcorp · Richmond, Virginia
Specimen date
April 28, 2026
Result
Negative

To whom it may concern,

I have personally reviewed the above patient's tuberculosis screening result. The QuantiFERON-TB Gold Plus result is negative for this screening draw.

This letter documents the reviewed TB screening result for an educational or occupational requirement that requests TB screening documentation. It is not a general medical clearance, a work-readiness determination, or a guarantee of acceptance by the receiving institution.

Should the receiving institution require clarification or additional documentation, please contact our office at the email address on this letterhead.

Andrew Overbey, FNP-BC, ENP-C

Family & Emergency Nurse Practitioner
Virginia License #0024172132 · NPI 1104220367
Practiclear · practiclear.com