Commercial parlor/shop Correctional facility Other / Prison Jail Juvenile facility Page / Hospital Name / /
IndustryTerm
blood products / /
MedicalCondition
acute hepatitis B / Acute Hepatitis C / sexually transmitted disease / hepatitis A / False Hepatitis B / Acute Hepatitis D / Chronic Hepatitis D / HBV / acute illness / symptoms AND Hepatitis B / hepatitis E / acute hepatitis / hepatitis C / hepatitis B / HCV / vaccine hepatitis B / hepatitis D / False Hepatitis C / NOT acute hepatitis / hepatitis infection / VACCINE HISTORY hepatitis A / viral hepatitis / hepatitis / chronic hepatitis B / False Hepatitis D / Chronic Hepatitis C / C virus infection / HCV RNA / HCV Genotype / /
MedicalTreatment
hemodialysis / acupuncture / surgery / / /
Position
Investigator / law enforcement/correctional officer / signature Area Medical Director / public safety worker / signature Date Health District Supervisor / /
Microsoft Word - VirHepBC2