WORKERS' COMP by 3E5Y1t

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									        WORKERS' COMP. INJURY (BBP EXPOSURE) SOURCE TESTING
 DEPARTMENTS MUST NOTIFY RISK MANAGEMENT BY TELEPHONE (642-1544), E-
        MAIL (RGORDY@AIKENCOUNTYSC.GOV) OR FAX (643-1994)


NAME:              DATE

FROM:             Ruth L. Gordy, Risk Manager, Aiken County Government
TO:               Doctor’s Care
PHONE/FAX:        648-1464/649-2027 (Aiken Mall)
                  648-4119/648-4989 (North Side)
                  279-4120/279-5418 (North Augusta)

Please perform the treatment/procedure indicated below. If there are any questions, please call
642-1544.

   (Hepatitis B Surface Antigen (HbsAG); Hepatitis A IgM Antibody; Hepatitis C Antibody,
      EIA; HIV Antibody)

   NO Drug/Alcohol Test

Use the following accounts:

      Patient Account (Workers' Comp.) – Apply to the w/c claim for the employee involved in
the BBP exposure.


PLEASE FORWARD HCFA1500 & NOTES TO:
  Ms. Gwen Gerisch
  Hewitt, Coleman & Associates, Inc.
  P.O. Box 6528
  Greenville, SC 29606

   Tel: 800-421-9139, x 819 / Fax: 864-233-2486

								
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