Hepatitis C Screening Form
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Hepatitis C Screening Form
Risk assessment intake for hepatitis C virus screening and follow-up care.
Patient Information
Full name *
Your answer
Date of birth
Phone
Risk Factors
Born between 1945 and 1965?
Have you ever injected drugs (even once)?
Received blood transfusion before 1992?
+ 9 more questions
About this template
Risk assessment intake for hepatitis C virus screening and follow-up care.
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