1. Date | Time exposure began: | 2. Date | Time | Lymphocyte count from one or more blood samples: | | | | | | 3. 4. Gy is the estimated dose Gy 95% confidence limits 5. for hematopoietic subsyndrome based on this dose. Note: See the following for additional details: http://remm.nlm.gov/aboutlymphocytedepletion.htm
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