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Patient name (Patient Label) Department for Public Health Tuberculosis Prevention and Control Program REPORT OF TUBERCULOSIS SCREENING Date Name DOB TO WHOM IT MAY CONCERN: The above named individual

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How to fill out based on form available:

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3. Verify the form version: Make sure that the form you are using is the most recent version available. Forms are often updated, and using an outdated version may result in errors or delays in processing.
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8. Review and proofread: Before submitting the form, review all the entered information to ensure its accuracy. Proofread the form for any spelling or grammatical errors.
9. Sign and date: If the form requires a signature, make sure to sign and date it in the designated space. Follow any additional instructions related to signatures, such as getting them witnessed or notarized.
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What is based on form available?

Based on form available is a document used to collect specific information for a particular purpose.

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Individuals or entities specified in the instructions of the form are required to file.

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Fill out the form by following the instructions provided and entering the required information accurately.

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The purpose of the form is to gather necessary data for a specific purpose or to comply with certain regulations.

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The form requires reporting of specific details as outlined in the instructions, such as personal information, financial data, or other relevant information.