Get Post-exposure Follow-up Form - University Of Virginia - Virginia

The Post-Exposure Follow-up Form from the University of Virginia serves as a crucial document for recording incidents of exposure to bloodborne pathogens. This guide aims to provide clear and supportive instructions on how to fill out this form effectively in an online format.

Follow the steps to complete the Post-Exposure Follow-up Form online.

1. Select the ‘Get Form’ button to access the Post-Exposure Follow-up Form and open it in your preferred online editor.
2. Begin by entering the date of injury or exposure in the designated field, ensuring the correct format is used: MM/DD/YYYY.
3. Fill in the source patient details. You will find multiple fields where you can provide information about the source patient, indicating if they are identifiable and whether they have been tested for pathogens.
4. Complete the section regarding the source patient's test results for pathogens such as Hepatitis B, Hepatitis C, and HIV. Circle the results applicable to your situation.
5. State if the source patient belongs to a high-risk group for bloodborne pathogens by checking the appropriate boxes provided.
6. Detail any treatment received by the source patient for HIV, as well as providing comments if necessary.
7. Next, fill out the health care worker's information, specifying whether they have been seen by an employee or in an emergency room.
8. Indicate if the health care worker has been vaccinated against HBV prior to exposure, along with their antibody levels, if tested.
9. Record results of baseline tests for the health care worker in the provided sections, ensuring that accurate information is provided for each pathogen.
10. Specify the post-exposure treatment or prophylaxis provided to the health care worker and fill in the relevant dosages and dates.
11. Document the results of follow-up tests using the designated sections. You can record multiple results for each pathogen as needed.
12. Finally, utilize the space available for additional comments regarding the exposure incident, ensuring clarity and completeness.
13. Once all fields are completed, you can save your changes, download the form for your records, print it if necessary, or share it as required.

Complete your Post-Exposure Follow-up Form online today for timely reporting and support.