Boots Colleagues Registration & Questionnaire for Needle Stick Injury aftercare

You have had a needle stick injury with a used needle or sharp and, as instructed in the Boots process, attended A&E in the first instance. A needle stick injury aftercare appointment has been recommended and you will need to contact Doctorcall for further assessment. In order to complete an assessment you will require details of your Hepatitis B vaccination history (with dates).

In order for us to advise you of your nearest network clinic and give you details of how to arrange your appointments we need you to register with Doctorcall by completing the form below.

First Name* Surname* Date of Birth*

Gender MaleFemale

Address* Email address* Please provide an email address to which you are happy to receive personal information Daytime Telephone Mobile Telephone Staff number* What date did the needle stick injury occur?* Job Title*

Question 1.

Please give details of the treatment you received in the Hospital A&E for your needle-stick injury?

Question 2.

Are you immune to Hepatitis B?

Yes You will have completed a primary course of Hepatitis B vaccinations. You do not need to answer any further questions. Doctorcall will contact you shortly with instructions for your needle-stick aftercare. No / Don't Know You will need to complete your course of Hepatitis B vaccinations as part of your needle-stick aftercare. Please answer Question 3. Doctorcall will contact you to arrange appointments.

Question 3.

Have you had an anaphylactic reaction to the ingredients of hepatitis B vaccine in the past?

Yes You should not have another hepatitis B vaccination. No Please answer Question 4.

Question 4.

When have you had Hepatitis B vaccinations previously?

Please provide details of any Hepatitis B vaccinations you have had, with dates.

Question 5.

Is there any further information given to you at A&E that we should know?

Doctorcall will contact you to arrange follow up appointments.

Receive latest offers and news

Your personal information will be held securely and kept private. We will exclusively use the information you submit to provide a quotation. You will not be added to our mailing list without your permission. View privacy policy

Additional Information

1 to 4 months after completing a primary course of Hepatitis B vaccinations, you will be given a Hepatitis B immunity test. Once immunity has been established you will require booster at 5 years.

5 years after completing a primary course of Hepatitis B Vaccinations, you should arrange for a 5 year booster from a Boots Travel Vaccination Pharmacy.

If you had vaccinations in the past as part of a primary course of Hepatitis B vaccinations which was not completed, you may need to start the primary course again. Doctorcall will advise depending upon the information you have provided.

If you have any queries, please contact the Doctorcall Medical Assistance Team by email at Boots@doctorcall.co.uk, or by fax on 0161 834 5827 quoting your full name and date of birth in all correspondence.

I declare that to the best of my knowledge and belief, the information contained herein is complete and true.

Boots Colleagues Registration & Questionnaire for Needle Stick Injury aftercare