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Get University Of Memphis Incident Report Exposure To Blood Or Other Potentially Infectious Materials 2016

Supervisor Name: Supervisor Title: Date of Exposure: Time of Exposure: Was Protective Equipment being used? A.M. P.M. Yes No Source of exposure (if pricked by sharps, include device used, type, and brand): HBV Status of Source Positive Negative Unknown HIV Status of Source Positive Negative Unknown Explain how the exposure occurred: Describe the immediate action taken: Additional Comments: Incident was reported to: Has a physician referral been scheduled? Yes No I under.

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