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Rntcp Request Form for Examination of Biological Specimen for Tb
Migrant
Refugee Urban slum Health-care worker
Other(specify) ______
Name and Type of referring facility (PHI/DMC/TU/
DTC/ICTC/ART/Medical College/DR-TB Centre/Private
Others, specify): __________________________
CDL NIKSHAY ID: _ _ - _ _ _ - _ - C - _ _- _ _ _ _ _
RNTCP TB Reg No. __________________
Or
Health Establishment ID (NIKSHAY): _ _ _ _
State: _____________________
☐ Not Applicable
District:_______________ Tuberculosis Unit (TU): _________________
Reason for...
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