MCL Laboratories
Typical Outpatient Requisition Form- Required information
| Specimen Source |
Stamp Patient Card here |
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| Diagnosis | Collected by: | |||||
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Stat Routine |
Date | Time | ||||
| Physician Name | Service | Beeper | ||||
| Download a form? | ||||||
| General Lab | Special Lab | Microbiology | Special Hepatitis C form | |||