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New Hampshire Confidential Hepatitis B Provider Case Report Form (New Diagnoses and Perinatal Exposures Only) - New Hampshire
New Hampshire Confidential Hepatitis B Provider Case Report Form (New Diagnoses and Perinatal Exposures Only) is a legal document that was released by the New Hampshire Department of Health and Human Services - a government authority operating within New Hampshire.
FAQ
Q: What is the purpose of the New Hampshire Confidential Hepatitis B Provider Case Report Form?
A: The purpose of the form is to report new diagnoses and perinatal exposures of Hepatitis B in New Hampshire.
Q: Who is required to use the New Hampshire Confidential Hepatitis B Provider Case Report Form?
A: Healthcare providers who diagnose new cases of Hepatitis B or perinatal exposures to the virus are required to use the form.
Q: What information does the form collect?
A: The form collects information such as patient demographics, testing results, and vaccination history.
Q: Is the form confidential?
A: Yes, the form is confidential and protected under state law.
Q: Are healthcare providers required to submit the form electronically?
A: No, healthcare providers have the option to submit the form electronically or by mail.
Form Details:
- Released on March 17, 2022;
- The latest edition currently provided by the New Hampshire Department of Health and Human Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New Hampshire Department of Health and Human Services.
Download New Hampshire Confidential Hepatitis B Provider Case Report Form (New Diagnoses and Perinatal Exposures Only) - New Hampshire
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