Titer and TB Tests for School or Work: The 4 Health Clearance Tests You May Need

Four blood tests cover most school, clinical-training, and employment health requirements. Learn which one documents what, and how to match your form to the exact test before you order.

Medically Reviewed By: Rhonda Collins, FNP-C | September 22, 2026 | 11 min read

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Four blood tests cover most health requirements for college and graduate programs, clinical rotations, healthcare jobs, new employment, volunteering, and professional training: QuantiFERON-TB Gold Plus, MMR immunity, varicella immunity, and hepatitis B surface antibody, quantitative.

Only three of them are immunity tests. QuantiFERON-TB Gold Plus is a tuberculosis screening test that looks for evidence of TB infection. The MMR, varicella, and hepatitis B tests measure antibodies associated with immunity or vaccine response. That difference matters because a TB requirement can never be satisfied by an antibody test, and an immunity requirement can never be satisfied by a TB test.

You almost certainly do not need all four. Requirements vary by school, employer, occupation, state, and individual health history, so read your form first and order only what it names.

Quick reference: the four tests

Check these things on your form before you order

Most ordering mistakes come from skipping this step. Before you buy anything, confirm:

1. The exact test name and method. “TB test” can mean a blood test or a skin test. “Varicella titer” can mean a qualitative result or a numeric one. Order what the form names.
2. The result format. Some forms accept a qualitative immune or not-immune result. Others have a blank for a number, which means you need a quantitative assay.
3. How recent the result must be. Many programs set a window, and an older result on file may not count even though it is still accurate.
4. The form and signature requirements. A laboratory report may be enough, or the program may require its own form, a clinician signature, or occupational-health review.
5. Who submits it. Some programs take an upload from you, and others want it sent from the clinician or lab.

If any of these is unclear, ask the office that reviews your paperwork before ordering rather than after.

QuantiFERON-TB Gold Plus

QuantiFERON-TB Gold Plus is an interferon-gamma release assay. It measures how immune cells in a blood sample respond to proteins associated with the bacteria that cause tuberculosis. The CDC identifies it as an FDA-approved IGRA for TB testing.

It is not an immunity test, and a positive result is not a diagnosis. A positive result supports TB infection but does not distinguish inactive infection from active TB disease, so it needs medical evaluation and further testing.

This page is the overview. For the TB-specific questions that come up most:

• What schools and employers may require, and how long a result stays valid
• How the TB blood test compares with the PPD skin test
• When to test after a known exposure
• What a QuantiFERON-TB Gold Plus test costs

Measles, mumps, and rubella (MMR) immunity

The MMR immunity test measures IgG antibodies for all three diseases in a single order, which is what most clinical-training and healthcare-employment forms ask for.

The CDC lists laboratory evidence of immunity alongside written vaccination records, laboratory confirmation of disease, and birth before 1957 as acceptable presumptive evidence of measles immunity. If your program accepts a vaccination record and you have one, a blood test may add nothing.

If your form names rubella only, the combined test is more than you need. The standalone Rubella Antibody (IgG) Blood Test answers that question alone, costs less, and is available from more of our lab partners. There is no equivalent standalone measles-only or mumps-only test in our catalog, so a measles or mumps requirement goes through the combined MMR test.

Varicella immunity

Varicella IgG testing comes in two versions, and choosing between them is the decision this section exists for. Both measure varicella-zoster antibodies, the ones associated with prior chickenpox infection or vaccination. They differ in what they report.

For routine immunity documentation, your form is asking whether varicella IgG is detected, and the IgG presence test is the one that answers that question. Order the IgG quantity test only when your form or a clinician specifically asks for a numeric varicella IgG measurement.

A number is not a safe default. Not every school or employer accepts a quantitative result in place of a qualitative one, so ordering the numeric assay for a form that asked whether you are immune can get the result rejected. If the form does not say which it wants, ask before you order rather than after.

One limitation is worth knowing whichever version you order. The CDC notes that commercial varicella assays lack sensitivity to detect vaccine-induced immunity and can produce false-negative results, even though they work for assessing immunity from having had the disease. A negative varicella result in someone with a documented vaccination history is a known scenario, not necessarily a sign that protection is absent. Take that result to your program or clinician rather than acting on it yourself.

Hepatitis B surface antibody, quantitative

Clearance forms usually ask for the quantitative version because they want the number, not a yes or no. The value reported is your anti-HBs concentration in mIU/mL, which reflects antibody produced in response to hepatitis B vaccination or past infection.

The CDC states that anti-HBs levels of at least 10 mIU/mL are generally considered seroprotective. That is the threshold most occupational-health programs work from. It is also why a qualitative result can fail a form that has a numeric blank: the qualitative version does not report the value the reviewer is looking for.

This test measures antibody. It does not, by itself, establish whether you have an active hepatitis B infection, which is a different set of tests.

What a titer proves, and what it does not

“Titer” is not one test. It describes how an antibody is measured, not which antibody was measured or what the result means. MedlinePlus describes an antibody titer as a lab test that measures the level of antibodies in a blood sample, and the meaning of that level depends entirely on which antibody it is.

Three distinctions decide which test you order:

• Presence versus quantity. A presence, or qualitative, assay reports whether the antibody was detected. A quantity, or quantitative, assay reports a number. Neither one is a safe substitute for the other: a qualitative result cannot fill in a numeric blank, and a program that asked for a qualitative result may not accept a number in its place. Order the format the form names.
• Immunity titers versus other antibody titers. An antinuclear antibody titer or an antistreptolysin O titer is also a “titer,” and neither documents immunity to anything. Searching for a generic “titer test” is how people end up ordering the wrong assay.
• An antibody test versus an immune-response test. QuantiFERON-TB Gold Plus measures interferon-gamma release rather than antibodies, so it is not a titer at all, and a TB requirement can never be routed to an MMR, varicella, or hepatitis B product.

An equivocal result is a third category the laboratory defines for that specific assay, sitting between its positive and negative decision points. It is not a diagnosis and it does not carry one meaning across diseases. Programs differ on whether they treat an equivocal result as immune, so ask yours rather than assuming.

The ACIP recommendations for immunization of healthcare personnel are the reference many occupational-health programs build their forms on, and they treat documented vaccination and laboratory evidence as alternative forms of evidence rather than as a sequence you work through.

Which lab you use can change what you can order

Mito fulfills these tests through Quest Diagnostics, Labcorp, and BioReference, and not every lab carries every test. Which lab serves you depends on your state: Quest and Labcorp serve every state except New York, New Jersey, and Rhode Island, and BioReference serves those three.

Two things follow from that table:

• Outside New York, New Jersey, and Rhode Island, Labcorp carries all four of the routine tests, so a form asking for TB screening plus MMR, varicella, and hepatitis B documentation can be done in a single visit. The exception is a form that specifically demands a numeric varicella result: that assay runs at Quest, so pairing it with MMR or hepatitis B means two labs, two visits, and a draw fee at each, since the draw fee is charged per lab rather than per test.
• In New York, New Jersey, and Rhode Island, BioReference is the in-state option, and it carries neither the MMR immunity test nor the varicella IgG presence test. Those two are not orderable through Mito in those three states today, so the varicella question there goes through the quantity test. Confirm your program accepts a numeric varicella result before ordering it.

If your form needs more than one of these, check the lab on each product page before you check out and group what you can into a single visit.

If a result comes back non-immune, equivocal, or positive

A non-immune or equivocal antibody result is not a diagnosis and it does not mean you must be revaccinated. It means the assay did not detect antibody above its decision point, which can happen for several reasons, including the varicella assay sensitivity limitation above. Your program, your clinician, or your occupational-health team decides the next step, and that decision depends on your vaccination records, your history, and the requirement you are meeting.

A positive QuantiFERON-TB Gold Plus result is different in kind. It needs medical evaluation to distinguish inactive TB infection from active TB disease, and that is a clinical process rather than a paperwork one. If you have symptoms of TB disease, seek medical evaluation promptly rather than waiting on your form, even after a negative screening result.

An indeterminate QuantiFERON result establishes nothing either way. Depending on your risk and your program’s rules, repeating the blood test or using a different TB test may be appropriate.

Frequently asked questions

Do I need a doctor’s order to get a titer test?

No. You can order these tests yourself through Mito, and the lab order is generated for you. You do not need to bring a referral from your own clinician.

How much does a titer test cost?

It depends on the exact test, the lab, and your state, so the current price lives on each product page rather than here. For the TB test specifically, the QuantiFERON-TB Gold Plus cost guide compares all-in prices across providers.

Does insurance cover a titer or TB test for school or work?

Mito orders are self-pay, so insurance is not required and no claim is filed. Some schools and employers reimburse the cost or run their own occupational-health clinic, which is worth asking about before you pay out of pocket.

Where can I get these tests done?

At a partner lab draw location. After you order, you get a lab order form and can book a visit at a Quest, Labcorp, or BioReference location near you. Which network is available depends on your state, as described above.

My school gave me a TB test form. Can I attach a blood test result to it?

The form comes from your school or employer, not from the lab, and they decide what goes on it. Many forms have a section for a blood test result alongside the skin test, but some are written for a skin test only. Check which one yours is before ordering the blood test.

Do titer results expire?

Antibodies do not disappear on a schedule, but the document can still go stale for administrative purposes. Programs commonly require a result from within a set window, and that window is set by the program, not the laboratory. TB screening has its own timing rules, covered in the QuantiFERON for school or work article.

Your next step

Read your form, identify the exact tests it names, then order only those. If tuberculosis screening is the requirement, start with the QuantiFERON-TB Gold Plus test. If it is immunity documentation, go straight to the MMR, varicella, or hepatitis B surface antibody test your form asks for. For varicella, that is the presence test unless your form specifically asks for a numeric measurement.

This guide is for educational purposes and does not replace medical advice, diagnosis, or treatment.