Nama Penuh ${nama}
Alamat Emel ${emel}
No.Kad Pengenalan ${ic}
No. Telefon ${no-telefon}
Alamat Kediaman 1 ${alamat1}
Alamat Kediaman 2 ${alamat2}
Poskod ${alamat}
Bandar ${bandar}
Negeri ${negeri}
Lokasi Klinik ${klinik}
Tarikh Ujian Darah ${tarikh-blood-test}
Waktu Ujian Darah ${waktu-blood-test}
Pengisytiharan ${pengisytiharan}
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