Get Unprotected Exposure Form Ma

This guide provides clear, step-by-step instructions for completing the Unprotected Exposure Form Ma online. Designed for users, including those with little legal experience, this resource ensures you can navigate the form with confidence and accuracy.

Follow the steps to fill out the Unprotected Exposure Form Ma online effectively.

1. Click the ‘Get Form’ button to obtain the Unprotected Exposure Form Ma and open it in your preferred online editor.
2. Begin by entering today's date in the designated field. This date is essential for record-keeping and tracking the exposure.
3. Input the incident date in the specified format. This information helps to document when the exposure occurred.
4. Fill out the transporting ambulance service and receiving facility details, along with the ambulance trip report number. These details are crucial for tracing and accountability.
5. Provide the contact information of the designated infection control officer (DICO), including their name and telephone number, as this is vital for follow-up procedures.
6. Enter patient information, including the patient's name, incident location, and the type of incident (medical, trauma, transportation). This section helps identify the context of the exposure.
7. Document the rescuer information, including their name and contact numbers for day and evening. Accurate contact information is necessary for follow-ups.
8. Check the relevant exposure routes in the provided section. Options include needlestick, open cut, bite, puncture, mouth, eye, or other. Be as specific as possible.
9. Indicate the type of exposure by selecting relevant bodily fluids such as blood, sputum, saliva, or other. This information is crucial for assessing risk.
10. List the precautions taken during the exposure. Check all applicable boxes for safety measures such as masks, eyewear, gowns, and gloves.
11. Detail the cleaning and handwashing steps taken after the incident. This supports accountability and thoroughness in managing the exposure.
12. Describe the nature of the unprotected exposure in detail. Attach additional pages if needed to provide thorough context.
13. Explain the steps taken by the rescuer to minimize the exposure, ensuring clear communication of actions taken.
14. Sign and date the form with the rescuer’s signature. This legitimizes the submission.
15. Complete the section for form receipt, including signature and date from the receiving facility personnel.
16. Finally, save changes, download, print, or share the form with the necessary recipients as per your employer’s protocols.

Complete the Unprotected Exposure Form Ma online today to ensure your exposure is documented and addressed promptly.