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UCDAV1SSTUDENT HEALTH AN6ep

__

COUNSELING SERVICES

Student Health andCounseling ServicesUniversity or California

One Shields Avenue

______________________________

Davis, CA 95616-8711530.752.2300.tel530.752.5587.fax

hnp://shc. ucdovis.edu

Subject: Chicken Pox Exposure (example)Date: date umber of page : 2

(including Ihs cover I)

Comments:

Please read attached notice of exposure

Note: All inecheal uifrwrnario t i• privileged and it c’onJidenfiahry should b nan tan c/c ,‘n• the Privac v Ac,q1974. Medical rnforrnat cm trutj’ nut be/luther (I c’lusecl unless anvil erpanen, (i U ott itlOfl i cib/ti it

use or disclosure is 5; eewalIy r’qliired orpc’rmit/c a’ by law.

GONF!DENTM LIT? NOTIGL

‘rite a’ nil format a in this FAX message is confld’nticil tuici pr: it It’ c’d. It is ifi?hiIl jut for tiI7uIi?hari S pc’rWH

to r view, opy or chssenunare cvi ./zdeirnoi netheal injen’inanoi:. lithe r ‘cider o[ilw i’arnnl, I not the urench’d

r pit ii , cm are hereby i ofific d that ion tic vc’ rec’ez ed thi.c lAX inc.’. 1 ‘1’ In cl’i’ ii’ ((liii il;ni jevuc w or Jui liii,

diselti iii’ of the I if irination coma ned 1/ erein i. sint dv pivhibth’d. If ;‘cm have r’ct’, i’d ihi iii ‘sstc. t ill

el-mr ph’ci;c’ notify it i,nnu’diarelv a, the p/nine nunber inclh’c ml above to arrangc’far return rf ml e on, ‘taut

FAX trahl.’117155i011 by inc II.

Staff/Dept ChairTo: 1’

‘I

flax Cover Shed::

ment Name & tax (d.ni)

I)

I’

From:

You(name)

r name-andnumber

‘I

‘pinil’, I

UNIVIRSI’’Y OF CALIFORN.A, LMVIS

II I.J • I • lvii ‘.‘ ‘ ,aIII’I

— NI I’I ‘ii I- P %III.

-C.G3O)i’t1C5 irs

ii i.H7,.

M Provide as much classdetail as possible;

Diii- include CRN, Class &Section number and

ProfessorDear Professor,

a has come to the attention of the Stutnt Health Services that a student in yourclass Aj1. has contracted ch ckenpox. This studenthas been asked to stay out of classffor six days. We would appreciate yournot[flcation of classmates that thjwere exposed; however, no health precautionsor medications are necessary atiis time. Students might want to check with the,rparents or personal physician o see :f they have received pror vaccination or areaireidy immune to this dise

Add;tional information ab t di ckenpox can be found on the CDC webste (Center[a- Dsease Control) ww .r, • Or, call an advice nurse at Student HealthServLces at 752-2349.

CtAi yY%’1