Testing the form Submitter: Hdhd Labortory: Jejd Labortory Address: Yshs Director: Ushs Georgia Clincial Labortary Licencse #: Hshd CLIA ID#: Hdbs SPECIMEN SUBMITTER:: Hsbs Phone: Bdbd Lab NO:: Hsbs Patient Name: Bdbd Gender: W MED REC: Bsbs ETHNICITY: W Address: Bsbs Race: Bsbs DOB: Bsbs Race: Bsbs Phone: Bdbd Age: Bsb COLLECTED: Hshd RECEIVED: Bsbs REPORTED: Bsbs SPECIMEN SOURCE:: Bsbs RPR w/Reflex : Hsb SYPHILIS TREPSURE (TREPONEMAL) : Hshs RECEIVED: Bsbs REPORTED: Bsbs HIV 1/2 Insti-Rapid : Hsbs SPECIMEN SOURCE:: Bsbs HIV RNA Combo Ag/Ab: Bsbs HIV Final Interpretation:: Bsbs SPECIMEN SOURCE: Bsbs GONORRHEA GC:: Habs TRICHOMONAS VAGINALIS: Bsbs Hepatitis Panel : Ushs
