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TB Examinations: Compliance Made Simple
Struggling to Stay Compliant with HCA TB Testing Requirements?
We make it simple. Learn exactly what California Health & Safety Code §1796.45 requires—and get the step-by-step tools to track, document, and prove TB compliance with confidence during inspections.
🚨 Avoid Fines: What California Law Really
Requires for TB Testing
One of the most frequently overlooked compliance areas in Home Care Organization (HCO) audits is proof of TB testing for Home Care Aides. Yet California law is clear: Every affiliated caregiver must undergo tuberculosis screening prior to or shortly after hire — and maintain valid documentation thereafter.
Failure to comply can result in costly citations, revoked registrations, or disqualification from providing care.
This page helps you:
✅ Understand exactly what California law requires
✅ Know when exams are due (and when they're not!)
✅ Learn how to document correctly
✅ Avoid common mistakes agencies make during audits
⚖️ California Law - Health & Safety Code §1796.45:
What the Regulations Actually Require
📜 What Does the Law Say?
Under California Health & Safety Code §1796.45, all affiliated home care aides must complete a TB examination that meets CDC and FDA standards.
Here’s what’s required:
“Affiliated home care aides hired on or after January 1, 2016, shall submit to an examination 90 days prior to employment, or within seven days after employment, to determine that the individual is free of active tuberculosis disease.” — HSC §1796.45(a)
🔍 What Is a TB “Examination”?
A compliant examination includes:
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Step 1: A TB infection test recommended by the CDC (e.g., a TST or IGRA blood test) and approved by the FDA.
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Step 2: If the result is positive, the aide must get a chest X-ray.
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Step 3: A medical provider must certify that the aide is free of active TB.
Note: No aide may begin client contact until this documentation is received.
🧾 What Must Be on File?
Each affiliated aide must have:
🗂 A certificate or note from the examining medical
professional stating they are free from active TB
🗓 Dated proof of initial test and follow-up exam if applicable
💼 If transferring from another HCO: a copy of the prior valid
certificate
Agencies must retain this documentation in the caregiver’s medical personnel file for auditing purposes.
🔁 What Are the Ongoing Requirements?
SITUATION REQUIRED ACTION
New Aide Hire TB test must be completed within 90
days before or 7 days after hire.
Negative Result Repeat TB test every 2 years.
Positive Result + X-ray No repeat test required unless
symptoms arise.
Transferring Aide Accept TB exam certificate from a prior
agency only if:
> The certificate is less than 2 years old
> It documents a negative result or X-
ray clearance
> A printed record showing affiliation
with the previous Home Care
Organization prior to the date of
affiliation with your agency is on file
in the aide’s medical compliance folder
During real agency audits, our team continues to uncover serious TB testing compliance gaps, including:
❌ TB test results dated after client contact or after the hire
date
❌ Missing or incomplete TB Examination reports
❌ No documentation of follow-up testing for positive TB results
❌ TB clearance documentation not signed or dated by a
qualified medical professional
❌ No record of bi-annual TB testing or risk assessments for aides
working past 24 months
⚠️ In 2026, CDSS is expected to begin imposing fines and penalties for repeated or willful violations, including gaps in TB examination documentation.
🩺 Common Mistakes We’re Finding in Agency TB Compliance Files
🛠️ How to Comply: Step-by-Step Guide
Step 1: Pre-Hire or New Hire Screening
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Instruct caregiver to get a CDC-recommended TB test.
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Ensure they visit an approved clinic, urgent care, or occupational health provider.
Step 2: Positive Test Handling
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If positive, schedule a chest X-ray immediately.
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Only after clearance from a medical professional can the aide begin work.
Step 3: File Documentation
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Collect a signed, dated statement from the provider indicating the aide is free from active TB.
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File in the caregiver’s medical compliance folder.
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Input the expiration date into your HR or compliance tracking system.
Step 4: Monitor & Re-Test
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Re-test every 2 years for negative results.
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For positive results with X-ray clearance, no further testing required unless symptoms present
Step 5: Transferring Aides
Accept TB exam certificate from prior agency only if:
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Less than 2 years old
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It clearly documents a negative test or post-X-ray clearance
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You have printed proof of affiliation to prior agency prior to affiliation to your agency
📂 Free Tools to Help You Stay
Compliant
Click below to access our downloadable templates:
🔗 Tuberculosis (TB) Examination Clearance Form
🔗 Personnel Compliance File Checklist
🔗 PDF Summary: HSC §1796.45 Requirements
