Immunization. The nursing home shall offer influenza and pneumococcal immunization to each resident. The nursing home shall obtain written consent to administer the immunization from: The resident; or The resident's representative. A resident is not required to receive the influenza and pneumococcal immunization if it is: Medically contraindicated; Against the resident’s religious beliefs; or After being fully informed of the health risks associated with not receiving a vaccine, the resident refuses the immunization. If the resident refuses to be immunized, the nursing home shall document the refusal and the reason for the refusal. The nursing home shall notify each prospective resident of the immunization requirements and request that the resident agree to be immunized. The nursing home shall make available to residents educational and informational materials relating to immunization against influenza virus and immunization against pneumococcal disease. Tuberculosis Assessment. The nursing home shall assess residents for tuberculosis according to the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Settings. A new resident shall receive a two-step tuberculin skin test within 10 days of admission to the nursing home unless the resident has had: A documented negative tuberculin skin test within the previous 12 months; A previous positive tuberculin skin test; A history of preventive therapy treatment; A latent infection; or The treatment of active tuberculosis. The nursing home shall continue to monitor residents for signs and symptoms of tuberculosis by performing a yearly symptom review. When a resident has signs and symptoms of tuberculosis, a physician shall be notified to: Evaluate the resident for possible tuberculosis in a communicable form; Notify the health officer within 24 hours if the physician suspects tuberculosis; and Coordinate management of the resident and the resident’s contacts with the local health officer. The nursing home shall assess and manage a resident with a history of a previous positive tuberculin skin test, a history of latent infection, or a previous history of active tuberculosis, in accordance with Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings.