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Get Clearview Complete Hiv 1 2 Form

W Complete rapid HIV test. Facility Information Facility Name Telephone Number First Name of HIV Counselor Sex Date of Birth Client Information Last Name First Name Male Female Clearview Complete Rapid HIV Test Results Date Negative (Nonreactive) Preliminary Positive (Reactive) Scheduled return for confirmatory test results Date: Time: Fax a copy of the preliminary positive test result to the HIV Program, confidential fax at 701.328.0356 Client s Signature Signature Notes.

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