Twin Cities and Suburbs Rural Minnesota Rural Minnesota’s 800 #’s		Ph. 651-731-2949 Ph. 763-549-8820 Ph. 1-800-483-9155	Fax 651-731-0081 Fax 763-549-8803 Fax 1-888-426-9319
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(check all that apply) Medical Exam Paramedical Exam Blood and Urine HIV Blood Only HOS(Urine Only) HOS HIV (Urine) Resting EKG Long Term Care Assessment Saliva (HIV, Nicotine, Cocaine) DBS (Dried Blood Spot) Treadmill Stress Test Chest X-Ray 1 View or 2 View Physical Measurements(Blood Pressure & Build) Blood Pressure Recheck Other Special Instructions