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: LPL/R/QF/2711
Dr.Lal PathLabs
Rohini Sector -18, Block E, Rohini, New Delhi-110085
Phone : 011- 30244100, 011-39885050
E-mail : lalpathlabs@lalpathlabs.com; Website: www.lalpathlabs.com
CONSENT FOR HIV TESTING
Lab No:
Date:
Name: Sex: Age:
Address:
Tel.: Mobile:
Consent:
I, the undersigned agree to get my blood tested for HIV Antibodies and provide my identification proof *. The significance and
relevant information of this test (Pre Test Counseling) have been provided to me.
Result:
In understand that my result will be kept confidential and authorize the following person / agency to collect my report.
Self Ref. Doctor Ref. Agency Relative
Post Test Counseling will be given by my attending Doctor.
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