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Get and Sign Tb Form Illinois
Federal
Regulations. The information contained herein is required for medical treatment at the
Student Health Center. Incomplete or inaccurate information may result in inability to
register for classes, cancellation of class registration, or cause improper decision/diagnosis
for your future medical care.
First
MI
Gender:
State:
Number:
Zip:
JSU ID#:______________
SS#:
_____-___-______
Birth date: __/__/____
U.S. Citizen (Circle):
Y
Tuberculosis Screening (Completed by Student)
1. Have...
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