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Get Notification Of Blood Or Bodyfluid Exposure Form

He exposed Emergency Medical Services Provider in compliance with IC 16-41-10-2. DIRECTIONS - PLEASE READ BEFORE YOU BEGIN: 3 Fill-in circles like this: 1 Print firmly and neatly. Not like this: 2 Only use pens with blue or black ink. Mark mistakes like this: 4 Print capital letters only and numbers completely inside boxes: A 2 C 3 5 Please complete all items on form. 6 Date format: MM/DD/YY or MM/DD/YYYY 7 Time format: HHMM - 24 hour clock SECTION 1: Information Regarding Emergency Medical.

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