| 1) H/O living outside Bangladesh | : | a) Yes | b) No |
| 2) Presence of BCG scar mark | : | a) Yes | b) No |
| 3) Previous H/O Tuberculosis | : | a) Yes | b) No |
| 4) H/O taking antituberculosis drugs | : | a) Yes | b) No |
| 5) TB contact history | : | a) Yes | b) No |
| 6) H/O smoking | : | a) Yes | b) No |
| 7) H/O Alcoholism | : | a) Yes | b) No |
| 8) H/O Drug misuse | : | a) Yes | b) No |
| 9) H/O Other illness | : | a) Yes | b) No |