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Get Hawaii State Doh Influenza Form

MEDICAL MICROBIOLOGY BRANCH HAWAII STATE DEPARTMENT OF HEALTH 2725 WAIMANO HOME ROAD PEARL CITY HAWAII 96782 DATE RECEIVED BY STATE LABORATORY STATE DEPARTMENT OF HEALTH ACCESSION NUMBER SPECIMENS COLLECTED FOR INFLUENZA SURVEILLANCE ONLY CLINICAL DIAGNOSIS INFLUENZA LIKE ILLNESS SPECIMEN PRIORITY IDENTIFICATION PLEASE FILL OUT COMPLETELY NAME AND ADDRESS OF PHYSICIAN/SCHOOL/FACILITY ILINET SENTINEL PROVIDER ID YES NO UNK PATIENT HOSPITALIZED // .

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