Healthcare Personnel Log (That Have Contact With Suspect And/or Confirmed Ebola Case)

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List (1) and Log (2) for Healthcare Personnel that have Contact
with Suspect and/or Confirmed Ebola Case
1)
/
LIST ALL STAFF WHO ARE
WERE IN CONTACT WITH PATIENT
MR# (no PHI):
Date:
Time:
Room #:
Instructions: List information for healthcare personnel that have patient contact.
Name
Title
Department
Extension
Home phone
E-Mail
Copies to Infection Prevention (Ext XXXX), Emergency Management (Ext XXXX), and Employee Health (Ext XXXX)

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