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REPORT OF POTENTIAL EXPOSURE FORM FOR PREHOSPITAL RESPONDERS SECTION A: TO BE COMPLETED BY THE PREHOSPITAL RESPONDER WITH ASSISTANCE FROM THE AGENCY DO (PLEASE PRINT) Submitting Agency: Submitting
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Begin by gathering all relevant information and documents required by the DHSS (Department of Health and Social Services).
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Fill out the required personal information accurately, including your full name, address, contact details, and any other requested details about yourself or your organization.
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Make sure to provide the necessary information about the agency or program you are representing, including its name, address, and contact information.
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Follow any specific instructions provided by the DHSS regarding additional forms or documentation that may be required to complete the submission process.
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Submit the filled-out form to the DHSS through the designated method specified in the instructions (e.g., online submission, mail, or in-person).
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Individuals or organizations that are seeking to access or apply for any services, programs, or benefits provided by the DHSS may need to submit information to the agency.
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Submitting Agency - DHSS stands for Submitting Agency - Department of Health and Social Services.
Certain healthcare providers and facilities are required to file Submitting Agency - DHSS.
Submitting Agency - DHSS can usually be filled out electronically through an online portal provided by the Department of Health and Social Services.
The purpose of Submitting Agency - DHSS is to track and monitor healthcare data for regulatory and statistical purposes.
Information such as patient demographics, diagnoses, treatments, and outcomes must be reported on Submitting Agency - DHSS forms.
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