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Next Steps Worksheet Trillium Gift of Life Network Provide information to the Provincial Resource Centre[removed]or[removed]TGLN # __________________
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Document Date: 2013-10-15 15:35:01

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Facility

In hospital / /

IndustryTerm

blood products / /

MedicalCondition

active sepsis / pneumonia / Cancer / Diabetes / /

MedicalTreatment

antibiotics / /

Organization

Provincial Resource Centre / /

/

Position

Coordinator / Attending/Pronouncing Physician / Family Physician / /

Technology

x-ray / /