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LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test performed (unless previous positive skin test documented). Communicable TB disease

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LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test performed (unless previous positive skin test documented). Communicable TB disease

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Page 1: LIC 701 (1/98) (Confidential) have Physician: Address ...Risk factors present; Mantoux TB skin test performed (unless previous positive skin test documented). Communicable TB disease
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