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City Burlington / / Company ZIP Co / / MedicalCondition Significant Injury / Allergies / Liver Disease / Cancer / COPD / Diabetes / Kidney Disease / Significant Medication Error Staff Injury / Seizures / HIV/AIDS / / Organization Vermont Department of Health Div. of Alcohol and Drug Abuse Programs / Agency of Human Services Critical Incident Form Please / / / Product Significant Medication / / ProvinceOrState Vermont / / Technology ale / /
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