Ireland's Health Services
MANAGEMENT OF EXPOSURE INCIDENTS IN THE EMERGENCY DEPARTMENT FORM
TO BE COMPETED BY EMERGENCY DEPARTMENT
This Form should be completed in BLOCK CAPITALS USING A BLACK BALLPOINT PEN
MANAGEMENT OF EXPOSURE INCIDENTS FORM
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| |Date: |
|Name / DOB – ED Label | |
|Please make wide enough for labels (14 per page) | |
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| |Time: |
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| |Attending Doctor: |
|Clinical details – History and Examination |
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IS THE EXPOSURE SIGNIFICANT
If YES to any of the following, the exposure is significant. Circle the answer.
Body fluid splash into eye or mouth YES NO
Bites with breach of skin YES NO
Body fluid splash onto non-intact skin YES NO
(e.g. wound ................
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