Detection begins at intake, when correctional officers identify any inmates who exhibit signs and symptoms of TB. Anyone exhibiting these signs is immediately masked and escorted directly to the jail clinic. Medical screening is routinely done within 6 hours of booking. Screening for TB continues for all inmates remaining in the correctional system during health appraisal. Health appraisals are done within 72 hours, although State laws mandate 14 days. During this time, the Mantoux Tuberculin Skin Test is offered to all inmates. This preferred method of skin testing is done by intradermal injection of purified protein derivative (PPD) on the inner forearm. A TB instruction sheet given to each inmate who receives the PPD skin test assists the inmate with medical follow-up for a PPD skin test after release. Systemic problems remain in identifying and preventing TB, however. First, although PPD skin testing is strongly encouraged, it is not mandated. Second, the time frame between the confirmation of a positive PPD test and the chest X- ray is 13 days. Third, the system lacks a TB screening program for correctional staff.