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Th TB Technical Instructions 2007 and the DS-3030 Name (Last, First, MI.) , Photo Birth Date (mm-dd-yyyy) , Sex: Birthplace (City/Country) M F / Prior Country Present Country of Residence U.S. Consul (City/Country) Passport Number / Alien (Case) Number Date of Medical Exam (Date of TB physical exam or date of lab report of final TB culture results, if cultures performed) (mm-dd-yyyy) Date Exam Expires (3 months if Class A TB, or Class B1 TB, otherwise 6 months) (mm-dd-yyyy) Exam Place (.

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