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Get Lic Elisa For Hiv Form

Be assured: Age/Sex : EXAMINATION OF BLOOD FOR HIV I & II TEST HIV I & II RESULT : : Method : I declare that the person examined signed (affixed his/her thumb impression) in the space earmarked below, in my presence and I am not related to him/her or the Agent or the Development Officer. Dated at on the day of 200 Signature of the L.A. Pathologist s name & Address at a.m./p.m. Signature of the Pathologist Qualification: LICI Code No:.

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