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Get DHHS 2124 2009

Le Disease Branch ATTENTION HEALTH CARE PROVIDERS: Please report relevant clinical findings about this disease event to the local health department. Confidential Communicable Disease Report—Part 1 NC DISEASE CODE (see reverse side for code) Patient’s Last Name Patient’s Last Name First Middle First Birthdate (mm/dd/yyyy) Suffix Middle Suffix Sex Instructions for completing the Communicable M FDisease Trans. Report Form can be found in the NC Public Health Patient’s Street A.

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