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Referral Form - Example


Columbus Public Health created a two sided referral card for their Adult High Risk Hepatitis Program. One side of the card has modifiable information about the  immunization clinic including their office hours, address, and telephone number. The other side has patient information including the date, patient's name, identified risk, and employee signature.



Infectious Disease Prevention and Control Toolkit

Keyword Area:

Immunization, Infectious Diseases, Workforce Competency


Institutional Author:

Columbus Public Health




