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Patient Requisition Form Quicksilver Scientific

Patient Requisition Form Quicksilver Scientific

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Instructions and help about Patient Requisition Form Quicksilver Scientific

this this information here will be filled in by the covet 19 specimen collector you will start with your name middle initial last name street address any apartment number city state zip code cell phone email your birth date to put in there which month you were born in and then you put in the year that you were born and then you select the day of the year that you were born and that will enter then the date i'm going to put today's date in there just to make it simple but we want to put in your actual birth date there it's important because that's used for the uh the lab to make sure that you get your results properly then you put in your gender here if you've been vaccinated you put in the vaccine that you've received and the dates that you received those vaccines if not you can collect none check none have you previously tested positive for kobe 19 if so then you would fill that this information here um just check off the boxes um if the

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