
Get the free Microsoft Office InfoPath - Virus HIV - NYC.gov
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Virology Section-NYC DOHMH 455 First Avenue New York NY 10016 TEL 212 447 2864 FAX 212 447 2877 HIV ANALYSIS FOR LAB USE ONLY PUBLIC HEALTH LABORATORY TEST REQUEST Required information Please print clearly DATE MM/DD/YYYY 1. DOHMH bureau B. DOHMH contact Specimen type MM/DD/YYYY DOHMH REQUEST if checked complete A B below c BSTD g c OTHER specify BCD c AM g c PM DOHMH EVENT CODE First Name Last Name c Serum g c Other specify type c Plasma g c Whole Blood g Additional testing information c Yes...
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