hiv抗体确证检测报告单

HIV抗体确证检测报告单РREPORT OF HIV ANTIBODY CONFIRMATORY TESTINGР秘密SECRET 编号NO.Р送检单位РFROMР送检日期РDATEР年月日РYEAR MONTH DAYР送检样品РSPECIMENР全血□血浆□血清□Р唾液□尿□其它:_____Р送检人群РPOPULATIONР姓名РNAMEР年龄РAGEР Р性别РGENDERР职业РOCCUPATIONР国籍РNATIONALITYР民族РETHNICSР婚姻状况РMARRIAGEР文化程度РEDUCATIONР身份证号РID NUMBERР□□□□□□□□□□□□□□□□□□Р联系电话РPHONEР现住址РADDRESSР_____省_____市_____县_____乡(镇、街道)_____村_____(门牌号)Р户籍地址РPERMANENT ADDRESSР_____省_____市_____县_____乡(镇、街道)_____村_____(门牌号)Р检测方法РMETHODР日期РDATEР检测结果РRESULTSР筛查试剂1Р筛查试剂2Р筛查试剂3РWB带型Р*结论 CONCLUSIONР阳性□阴性□不确定□Р检测者РOPERATORР Р复核者РREOPERATORР签发者РHEADР报告日期РDATEР 年月日РYEAR MONTH DAYР确证单位或实验室(公章)РINSTITUTION ORLABORATORYР备注 NOTEР中国疾病预防控制中心制订РPRINTED BY CHINESE CENTER FOR РDISEASE CONTROL AND PREVENTION Р*抗HIV阳性一律盖红色章