U.s. department of state omb no. 1405-0113 expiration date: 08/31/2014 estimated burden: 10 minutes (see page 2 - back of form) medical examination for immigrant or refugee applicant for use with tb technical instructions 2007 and the ds-3030 name...
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1 waycross judicial circuit drug court phase change packet (phase to phase iv) participant name: counselor: currently in phase: requesting phase: to be completed by counselor: completed treatment goals and objective for phase : no positive drug...
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The quality clinical pathology service rabies serology certificate use one submission form per animal. send a minimum of 1ml serum (preferably) or 2ml clotted blood. clearly label sample with owner s name, animal s name and microchip number....
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Bara trac i and bara trac i too may 26, 2012 and may 27, 2012 north iowa fair grounds - mason city, ia usef/usdf# 242427 and 326256 important: please see the "general regulations and entry specification section" for additional policies that this...
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Friends of rochester hills public library membership application name: address street: city,state,zip: phone: email membership type: (please circle appropriate amount) individual $20 family 35 student/senior 10 donation please make all checks...
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Sample screening outreach script hello this is ; i am calling on behalf of dr. from the clinic. this is nothing urgent, just a routine call we are making. dr. wants to ensure that his/her patients are receiving the appropriate health screening to...
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Meningitis parent letter summer 2015 dear parent: i am writing to inform you about meningococcal disease, a potentially fatal bacterial infection commonly referred to as meningococcal meningitis. new york state public health law (nys phl) 2167 and...
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