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Designation Hiv Form
Victim
Designation of Health Care Provider/HIV Counseling and Testing Site
I designate ("X" one)
the health care provider named below to receive the results of the court ordered HIV/AIDS test performed on the child and to
disclose the child's test results to me. I understand that the health care provider may charge me (or my insurance
company) for any costs associated with disclosing the child's test results to me and that I am financially responsible for
these costs. I also understand that I...
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