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PATCH TESTING: PATIENT DATA FORM
Patient Name: ID#: Panel Placement Date/Time: Panel Removal Date/Time: Read Date #1: Read Date #2: Chamber: Read Date #3: series NA: North American Standard Series
#SKU1NA132READINGS
%VEHICLEbenzocaine5petrolatumNA052mercaptobenzothiazole1petrolatum3NA24colophony20petrolatum4NA07pphenylenediamine1petrolatum5NA75dimethylaminopropylamine
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