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Icmr Specimen Referral Form For Covid-19 (Sars-Cov2) : Section A - Patient Details
Icmr Specimen Referral Form For Covid-19 (Sars-Cov2) : Section A - Patient Details
B,CAMP,KNL
……………………………………………………………. (These fields to be filled for all patients including foreigners)
Pincode:
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SECTION B- MEDICAL INFORMATION
……………………………........................`..............................
Date of sample Sample accepted/ Date of Test result Repeat Sample Sign of Authority
receipt(dd/mm/yy) Rejected Testing (Positive / required (Yes / (Lab in charge)
(dd/mm/yy) Negative) No)
03-07-2020 CONFIRMA
00:00:00 TIVE
POSITIVE
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