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Hepatitis B Virus HBV Awareness DVD Request Form Please print clearly First name Last name Organization Mailing address City State ZIP Phone Email address Number of DVDs requested Each DVD contains all seven of the following languages English Somali Hmong Spanish Khmer Vietnamese Lao Email completed form to Margaret Kenyon-Schultz Minnesota Department of Health Questions about this DVD should be directed to Cheri Booth at cheri.
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Who needs hepatitis b dvd form:
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Individuals who have been diagnosed with or at risk of hepatitis B may need to fill out the hepatitis B DVD form.
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What is hepatitis b dvd form?
The hepatitis b dvd form is a document that collects information about cases of Hepatitis B, specifically in a DVD format.
Who is required to file hepatitis b dvd form?
Healthcare providers and facilities that diagnose or treat cases of Hepatitis B are required to file the hepatitis b dvd form.
How to fill out hepatitis b dvd form?
The hepatitis b dvd form can be filled out by providing the required information about each case of Hepatitis B diagnosed or treated, following the instructions provided on the form.
What is the purpose of hepatitis b dvd form?
The purpose of the hepatitis b dvd form is to collect data on Hepatitis B cases to monitor and assess the prevalence and impact of the disease.
What information must be reported on hepatitis b dvd form?
The hepatitis b dvd form typically requires information such as patient demographics, diagnostic information, treatment details, and other relevant data about each case of Hepatitis B.
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