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POST-EXPOSURE MEDICAL EVALUATION DECLINATION

I have been trained on OSHA safety policies and procedures. I understand that I could have contracted an infectious disease such as HIV, hepatitis B, or hepatitis C during the exposure incident described above. I also understand the consequences of contracting these diseases. I have been offered, free of charge, testing to determine whether I have contracted an infectious disease. I have also been offered a medical evaluation by a health care professional for counseling and treatment. Despite this, I freely decline this post-exposure evaluation and follow-up care.

 
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