Download PDF - Summit International School of Ministry
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Physical Examination Information (continued)Test Date ResultsPositive NegativeTuberculin (TB) Skin Test (within the last year)Chest X-Ray (required if TB Skin Test is positive)HIV Test (<strong>International</strong> applicants only)Additional CommentsPhysician InformationPrint Name AddressCity State Postal CodeTelephone NumberPhysician’s Signature:Date:21/25/2013
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