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မိနယ် ____________________

HTS Register ကျန်းမာေရးဌာန / အဖွဲအမည် ____________________

Pregnant Hospital HIV Test


Sex Spouse of Risk Categories Special Group Counseling Syphilis Hepatitis
woman Use Result Remarks
Exposed
Sr. Date Name ID Age Rapid (*/**/***/
(+) (-) Child RPR/
M F PP MP 1 2 3 4 5 6 7 8 9 10 11 1 2 3 4 1st 2nd 3rd Pre Post Test/ B C ****/ *****)
woman woman VDRL
ICT

Total

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