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  • JT Forms 04-17-2021

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    Kahel Jay Sta Maria
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    This document is a test result form from Health Priority Medical Clinic containing information about 2 patients - Vanessa Mapua and Jerome P. Adlawan. It includes their names, dates of birth, ages, sexes, dates and times their specimens were collected, the types of specimens collected (oral/nasal), their temperatures, and remarks. The form is signed and dated upon receipt by the medical clinic.

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    JT FORMS 04-17-2021

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    This document is a test result form from Health Priority Medical Clinic containing information about 2 patients - Vanessa Mapua and Jerome P. Adlawan. It includes their names, dates of birth, ages, sexes, dates and times their specimens were collected, the types of specimens collected (oral/nasal), their temperatures, and remarks. The form is signed and dated upon receipt by the medical clinic.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    11 views2 pages

    JT Forms 04-17-2021

    Uploaded by

    Kahel Jay Sta Maria
    This document is a test result form from Health Priority Medical Clinic containing information about 2 patients - Vanessa Mapua and Jerome P. Adlawan. It includes their names, dates of birth, ages, sexes, dates and times their specimens were collected, the types of specimens collected (oral/nasal), their temperatures, and remarks. The form is signed and dated upon receipt by the medical clinic.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Blg. No. 2120 2nd Floor, Service Road Roxas Blvd. cor Antipolo St. Zone 04, Brgy.

    11 District 1, Pasay City


    Email: jtcenica.acct@gmail.com
    Landline: (02)7089-4399; Globe: +63916-502-7699
    COMPANY: HEALTH PRIORITY MEDICAL CLINIC EMAILADDRESS: healthpriority2020@gmail.com
    DATE: APRIL 17, 2021 CONTACT PERSON: Maricel P. Ibay / Edgar P. Mutas Jr.
    TELEPHONE OR PHONE NUMBER: 7943-7317 / 0977-3359972 / 0995-2825513

    RATE
    (12HRS, DATE OF DATE TIME TYPE OF
    SEX SPECIME
    24HRS, SURNAME FIRSTNAME MIDDLE NAME BIRTH AGE COLLECTE COLLECT SPECIMEN TEMPERATU
    48HRS) (M/F N RE
    (MM/DD/YYY D ED (ORO/NAS REMARKS
    ) ORDER
    Y) (MM/DD/Y (HH:MM) O)
    Y)
    24 HRS MAPUA VANESSA 08/23/1986 34 F 04/17/2021 ORO/NASO

    24 HRS ADLAWAN JEROME P. 04/15/1998 23 M 04/17/2021 ORO/NASO

    .
    REMARKS: Receivedby: Signature:
    Date andTime:

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