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Hepatitis B Consultation Form Must be completed and returned to Student Health Student Name: Date of Birth: COM Campus and Class: Primary Care Physician: Specialist Consulting Physician: Date of Specialist
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How to fill out hepatitis b consultation form

How to fill out a hepatitis b consultation form:
01
Start by providing your personal information, such as your full name, date of birth, and contact details.
02
Next, indicate any relevant medical history, including previous hepatitis b vaccinations, if any.
03
Specify if you are experiencing any current symptoms related to hepatitis b, such as fatigue, abdominal pain, or jaundice.
04
If you have been exposed to hepatitis b or have any known risk factors, such as being a healthcare worker or having multiple sexual partners, make sure to mention it.
05
Indicate any previous testing or diagnosis of hepatitis b, including the dates and results of any blood tests.
06
If you are currently taking any medications, including antiviral drugs for hepatitis b, provide the names and dosages.
07
Consider mentioning any concerns or questions you have regarding hepatitis b or its management.
08
Lastly, sign and date the consultation form.
Who needs a hepatitis b consultation form:
01
Individuals who suspect they might have been exposed to hepatitis b or are experiencing symptoms related to the disease.
02
People who require evaluation and management for chronic hepatitis b infection.
03
Healthcare workers or individuals in high-risk occupations who need to be screened for hepatitis b.
04
Individuals seeking guidance on hepatitis b vaccination or management for themselves or their children.
05
Anyone with concerns or questions about hepatitis b and its prevention or treatment.
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