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Form 2b

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Lucian Raine Ladao
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122 views1 page

Form 2b

Uploaded by

Lucian Raine Ladao
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

FORM 2B.

NTP LABORATORY RESULT FOR HIV SCREENING OF TB PATIENTS


NAME OF REQUESTING FACILITY: DATE REQUESTED

PATIENT’S NAME (SURNAME, GIVEN NAME AND MIDDLE NAME) AGE SEX
[ ]M [ ]F

HIV SCREENING RESULT


LAB SERIAL NO. METHOD: KIT/REAGENT: LOT NO. RESULT:

MEDICAL TECHNOLOGIST (SIGNATURE OVER PRINTED DATE PERFORMED(MM/DD/YYYY) DATE RELEASED(MM\DD\YYYY)


NAME):

FORM 2B. NTP LABORATORY RESULT FOR HIV SCREENING OF TB PATIENTS


NAME OF REQUESTING FACILITY: DATE REQUESTED

PATIENT’S NAME (SURNAME, GIVEN NAME AND MIDDLE NAME) AGE SEX
[ ]M [ ]F

HIV SCREENING RESULT


LAB SERIAL NO. METHOD: KIT/REAGENT: LOT NO. RESULT:

MEDICAL TECHNOLOGIST (SIGNATURE OVER PRINTED DATE PERFORMED(MM/DD/YYYY) DATE RELEASED(MM\DD\YYYY)


NAME):

FORM 2B. NTP LABORATORY RESULT FOR HIV SCREENING OF TB PATIENTS


NAME OF REQUESTING FACILITY: DATE REQUESTED

PATIENT’S NAME (SURNAME, GIVEN NAME AND MIDDLE NAME) AGE SEX
[ ]M [ ]F

HIV SCREENING RESULT


LAB SERIAL NO. METHOD: KIT/REAGENT: LOT NO. RESULT:

MEDICAL TECHNOLOGIST (SIGNATURE OVER PRINTED DATE PERFORMED(MM/DD/YYYY) DATE RELEASED(MM\DD\YYYY)


NAME):

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