This government document is issued by Department of Public Health, Georgia Immunization Registry for use in Georgia
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https://www.google.com/url?client=internal-element-cse&cx=450907bf5042c4844&q=https://dph.georgia.gov/document/document/specimen-collection-outfit-order-form-unprotected-deca-11pdf/download&sa=U&ved=2ahUKEwju-I7QtPKKAxVVU6QEHYPIO0M4MhAWegQICBAB&usg=AOvVaw1h9b1beXZuhTOjUo3Qz0U8