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Get the free FOR CLINIC USE ONLY Tdap Td Hep B IPV MMR Mfgr. Lot ...

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AD RN please circle the following optional vaccines if declined: HPV, MCV4, Varicella VACCINE REQUEST FORM Trap TD Hepatitis B IPA (Check all that apply) MMR Hepatitis A MCV4 HPV Chickenpox Other
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Collect all necessary information and documents required for clinic use.
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Clinic staff, including medical professionals and administrative staff, may need to fill out forms for clinic use only.
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For clinic use only refers to items, documents or information that are intended specifically for use within a healthcare clinic or medical facility.
Any staff or personnel who handle sensitive medical information within a clinic are required to file documents or items as for clinic use only.
To fill out for clinic use only, simply mark the item or document with the phrase 'For Clinic Use Only' or 'Confidential - For Clinic Use Only' to indicate its restricted use.
The purpose of for clinic use only is to ensure that sensitive medical information remains confidential and is only accessed by authorized personnel within the clinic.
Any documents or items designated as for clinic use only must contain sensitive medical information that should only be accessed by authorized clinic staff.
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