检查报告 模板

TESTING REPORT

 

Name                                   Nationality                             

 

Sex                     Age                     Occupation                     

 

Country or region of departure                                                       

 

Country or region of destination                                                      

 

Department of Delivery                                                             

 

Date of Delivery                           Date of Report                           

 

 

 

Testing result of autibody HIV: Negative

 

 

 Technician                           Technician in charge                            

 

Entry-Exit Inspection and Quarantine Bureau of P.R.China

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