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Form Approved OMB No. 0920-0666 Exp. Date 12/31/2017 www. Primary Bloodstream Infection BSI Page 1 of 4 required for saving required for completion Facility ID Patient ID Event Social Security Secondary ID Patient Name Last Gender F M Other Ethnicity Specify Medicare First Date of Birth Race Specify Event Type BSI Post-procedure BSI Yes No NHSN Procedure Code MDRO Infection Surveillance Date of Event...
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