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Include area code DATE OF COLLECTION COUNTY ATTENTION TO PHONE NO. include area code FAX NO. include area code COMMENTS HEPATITIS INFORMATION --- RISK FACTORS R. F. BODY PIERCING MULTIPLE PARTNERS NON COMMERCIAL IV DRUG USER TATTOO NON-COMMERCIAL Blood transfusions Illicit non-IV drug use Healthcare worker Needle stick/blood splash Hemodialysis Pregnant due date History of incarceration Sexual contact Household contact Symptoms / Diagnosis of STD HIV INFORMATION select ALL that apply RISK...
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