Get Potential Pathogen Exposure (parts A And B). Potential Pathogen Exposure (parts A And B)

This guide provides clear instructions for completing the Potential Pathogen Exposure (Parts A and B) online. It aims to assist individuals who have experienced significant exposure to possible blood borne pathogens in accurately filling out the necessary forms.

Follow the steps to complete the Potential Pathogen Exposure (Parts A and B) form effectively.

1. Click ‘Get Form’ button to access the Potential Pathogen Exposure (Parts A and B) form. This will allow you to open the document and begin filling it out.
2. In Part A, provide your personal information such as your name, age, mailing address, and telephone number. Ensure all details are accurate and complete.
3. Enter the date and time of the exposure incident, being sure to specify whether it occurred in the AM or PM.
4. List the names, addresses, and telephone numbers of any witnesses to the exposure incident.
5. Describe the circumstances surrounding the exposure in detail, including any precautions used (e.g., mask, gloves).
6. Indicate the type of body fluid involved, such as blood or sputum, and the nature of the exposure, like a needle stick.
7. Specify if the needle or instrument was contaminated with visible blood, selecting yes, no, or unknown.
8. Note the body site exposed (e.g., hand, finger) and whether labs were drawn from the source patient.
9. In the medical evaluation section, provide any immediate recommendations or follow-up referrals related to the exposure.
10. For documenting any episodes of illness following the exposure, list relevant dates and symptoms.
11. After completing Part A, proceed to fill out Part B with the source patient information, following similar guidelines for accuracy and completeness.
12. Once you have filled out both parts, review all entries for correctness. You can then save the changes, download, print, or share the completed form as needed.

Complete your Potential Pathogen Exposure (Parts A and B) form online to ensure timely reporting and follow-up.