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III/Room materials

-Gauss

Yes

No

-If No, please comment: -----------------------------------------------------------------------------------------

No

Yes

-Disinfection materials

If No, please comment: -----------------------------------------------------------------------------------------

No

Yes

-Other

If No, please comment: -----------------------------------------------------------------------------------------

IV/Infection prevention:

No

Yes

-Equipment sterile

If No, please comment: -----------------------------------------------------------------------------------------

No

Yes

-Gloves are available and use

If No, please comment: -----------------------------------------------------------------------------------------

No

Yes

- Water availability

If No, please comment: -----------------------------------------------------------------------------------------

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