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Get Eform-R002 2005-2024

E your own letter. _____________________________________________________________________________________ DECLARATION OF PREGNANCY To: Vicky Barberini, Dosimetry Coordinator, Box 0942 Office of Environmental Health and Safety, UCSF In accordance with the NRC's regulations at 10 CFR 20.1208, "Dose to an Embryo/Fetus," I am declaring that I am pregnant. I believe I became pregnant in ________________________ (only the month and year need be provided). I understand the radiation dose to my embryo.

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