Blood sample._ __- heart ...... jugular other__ 
Plasma analysis __ ' Tests* VI HI N 
Plasma virus report VI: negative___positive vims _ 
HI: ____ __ __ 
HI:. .... . _ 
HI: ____ 
N: __ 
Blood smear___Stain(s) 
Blood smear results____ 
Remarks.. . .. 
