ANEXO 9 – ACOMPANHAMENTO DO ACIDENTE

PACIENTE-FONTE:
DIA DO ACIDENTE (____/____/____)
1ª BATERIA (D0)
- ANTIHBS (____/____/____): __________
- ANTIHBC Total (____/____/____):______
- HBsAg (____/____/____):_____________
- ANTIHCV (____/____/____):___________
- ANTIHIV (____/____/____):___________

ALUNO:
DIA DO ACIDENTE (____/____/____)
1ª BATERIA (D0)
- ANTIHBS (____/____/____): __________
- ANTIHBC Total (____/____/____):______
- HBsAg (____/____/____):_____________
- ANTIHCV (____/____/____):___________
- ANTIHIV (____/____/____):___________

PRIMEIRO RETORNO (____/____/____)

- ANTIHBS (____/____/____): __________
- ANTIHBC Total (____/____/____):______
- HBsAg (____/____/____):_____________
- ANTIHCV (____/____/____):___________
- ANTIHIV (____/____/____):___________

SEGUNDO RETORNO (____/____/____)

- ANTIHBS (____/____/____): __________
- ANTIHBC Total (____/____/____):______
- HBsAg (____/____/____):_____________
- ANTIHCV (____/____/____):___________
- ANTIHIV (____/____/____):___________