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新型コロナウイルス感染症自費検査申込
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検査の種類
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LAMP法
PCR法
検査希望日
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MM
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DD
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YYYY
証明書
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希望
希望【海外渡航用】
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お名前
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ふりがな
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性別
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男性
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住所
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電話番号
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メールアドレス
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