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University of Nebraska Medical Center Nebraska Medicine 2026
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- Click ‘Get Form’ to open it in the editor.
- Begin by entering your Print Name and Employee ID # in the designated fields at the top of the form.
- Next, provide the Date of Conception (Mo/Yr) to declare your pregnancy officially.
- Read through the exposure limits outlined in the document carefully. This ensures you understand your rights and responsibilities regarding radiation exposure during pregnancy.
- Sign and date the form where indicated, confirming your declaration of pregnancy.
- Fill in your Department and Zip code, along with Contact Information such as extension or email for follow-up.
- Provide the Print Name and Signature of your Immediate Supervisor, along with their Date.
- Finally, send the completed form to the Radiation Safety Office via email or postal service as instructed.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2019 | 4.8 Satisfied (213 Votes) |
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Related links
Jan 2, 2026 Nebraska Medicine serves as the primary teaching site for UNMCs educational programs, and Nebraska Medicine and UNMC have a shared foundationalRead more
Offering a wide range of programs in medicine, nursing, pharmacy, public health, and allied health professions, 206 South 13th Street, Suite 1000 Mon-Fri 9:00