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Exposure Medical Evaluation and Followup Form is to be completed by DUBS worker for the child at the time of each medical evaluation, regardless of custody status. Child's Name: DOB: (please print)

How to fill out exposure medical evaluation and

How to fill out exposure medical evaluation and

1. Step 1: Gather all pertinent information related to the exposure incident.
2. Step 2: Obtain the exposure medical evaluation form from your employer or healthcare provider.
3. Step 3: Fill out the personal information section, including your name, address, and contact details.
4. Step 4: Provide details about the exposure incident, such as the date, time, location, and type of exposure.
5. Step 5: Answer the questionnaire section regarding symptoms you may be experiencing.
6. Step 6: If applicable, provide details about any pre-existing medical conditions or medications you are currently taking.
7. Step 7: Sign and date the form to certify the accuracy of the information provided.
8. Step 8: Submit the completed exposure medical evaluation form to your employer or healthcare provider as instructed.

Who needs exposure medical evaluation and?

1. Anyone who has experienced an exposure incident in the workplace or any other setting where potential harmful substances or conditions were encountered may require an exposure medical evaluation.
2. This evaluation helps determine the potential health effects of the exposure and provides appropriate medical guidance and treatment if necessary.
3. Employers are typically responsible for identifying and ensuring that their employees who have had an exposure incident receive a medical evaluation to safeguard their health and well-being.

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