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Get Hiv Results Results Form Fillable 2010

On recorded on this form is confidential and not shared without your consent except as provided by law. See reverse side of this form for a listing of persons who may receive confidential HIV test results without needing an authorization, as specified under Wisconsin statute 252.15(3m). Name of person whose HIV test results will be released: Name and address of organization that I am authorizing to release HIV test results: Person(s) or organization(s) that I am authorizing to receive these HIV.

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