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REPUBLIC OF THE PHILIPPINES PROVINCE OF RIZAL MUNICIPALITY OF CARDONA OFFICE OF THE MUNICIPAL HEALTH OFFICER

Name:_____________________Date:__________Age:_____ Address:____________________________ Sex:______

REQUEST: __CBC __PC __Urinalysis __Fecalysis __HBsAg __Chest X-Ray

______________________ Eloida E.Silao,M.D Municipal Health Officer

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