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Get Bacteriologic Examination History - Health Ny

New York 12201-0509 Patient Last Name First Name Street Address City MI Sex DOB Zip Code / / MM DD YYYY County of Residence Specimen Specimen is: Source Isolate Primary patient material Date Collected Primary environmental material Submitter's Lab Number / / MM DD YYYY Food Other NYS DOH Outbreak Number (if applicable) Submitter Submitter Name and Address Laboratory PFI Contact Person Telep.

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