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I. American Indian/Alaskan Native Unknown Hispanic Origin Yes No HBsAg Result Date // EDC mm/dd/yyyy // Delivery Hospital OB Name Physician Address Physician Phone First M. I. Prior Pregnancies Dates If any other laboratory testing pertaining to Hepatitis B including LFTs anti-HBc etc. are done please fax these results to the Allegheny County Health Department. Person Completing Form Phone Fax completed Form to PeriHepBreportform-ID-0207 Attn Gregory Robes RN PHN Phone 412 578-7971 FAX 412...
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Perihepb report form-id-0207doc is a form used to report information related to perihepatic space.
Healthcare providers and institutions are required to file perihepb report form-id-0207doc.
The form must be filled out accurately and completely with all relevant information.
The purpose of the form is to gather data on perihepatic space for research and analysis.
Information such as patient demographics, medical history, and imaging findings must be reported on perihepb report form-id-0207doc.
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