Exposure to BloodBody Fluids

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OMB No. 0920-0666 Exp. Date 03-31-2011
Exposure to Blood/Body Fluids
required for saving
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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
3. What needle or sharp object caused the
injury? (Check one) ? Device (select one) ?
Non-device sharp object (specify) _______________
? Unknown sharp object
CDC 57.205 (Back)

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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
CDC 57.205 (Back)

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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
CDC 57.205 (Back)

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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
CDC 57.207 (Back)

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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
Note Section VIX are required when following
the protocols for Exposure Management.
mo/yr
mo/yr
CDC 57.205 (Back)

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Exposure to Blood/Body Fluids
OMB No. 0920-0666 Exp. Date 03-31-2011
CDC 57.205 (Back)

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