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Get PPCT Positive in Pregnancy Form

Day: ____ years SOCIAL/DEMOGRAPHIC HISTORY: Date of 1st positive HIV test: ______/______/_________ DD MM YYYY What is your occupation? ___________________________ Yes Has your partner been tested for HIV? No N/A Do you (or your family) generally have enough money to cover your expenses? Yes No What is your marital status? Highest level of education Single None Widowed/single Some primary Widowed/married Some secondary Married/living together Some college/university male, number of wives__.

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  3. Fill in the empty fields; involved parties names, places of residence and phone numbers etc.
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  5. Include the date and place your e-signature.
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  7. Save the ready-produced record to your system or print it as a hard copy.

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