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PATIENT REGISTRATION FORM
This Clinic only provides testing for: Chlamydia, Gonorrhea, Syphilis and HIV and only treats for: Chlamydia,. Gonorrhea, and Syphilis.
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Exceptional Circumstance Withdrawal (ECW)
Exceptional Circumstance Withdrawal Deadlines: Physician/Clinician of Family Member must complete the Primary Caregiver Certification Form provided by FAU.
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LAW ENFORCEMENT PHLEBOTOMY TOOLKIT:
Registration is required to access the free webinar recording. The Need for a The following information shall be documented on the form: 1. Medical Problems.
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