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Pre-Natal Screen
PLEASE FILL THE FOLLOWING DATA BEFORE YOU SUBMIT YOUR SAMPLE FOR SARS-CoV-2 ANTIBODY TESTS
MOBILE NO :
eMAIL id TO SEND REPORTS :
Name (50 chars) :
Age :
Gender :
MALE
FEMALE
Address with pin code :
Please enter Occupation like Doctor, Health Care worker , Lab Tech ect. :
Which of the following symptoms did you have in the last 30 days ?
Fever
YES
NO
Shortness of Breath
YES
NO
Cough
YES
NO
Sore Throat
YES
NO
Contact with COVID positive person/Relative
YES
NO
You have tested positive for COVID
YES
NO