Request for Testing Hemostasis Reference Laboratory (fill in 2026

1. Click 'Get Form' to open it in the editor.
2. Begin by filling out the 'Patient Identification' section. Enter the patient's name, date of birth, and sex (M/F). Ensure that this information matches the sample label.
3. In the 'Specimen Information' box, input the collection date and time. Select whether it was collected in the morning or afternoon.
4. Choose the tests required by checking the appropriate boxes under 'Routine Tests'. Refer to the drawing instructions for specific sample requirements.
5. Complete the 'Physician or Authorized Person Ordering Test' section with both first and last names. Include any necessary ICD10 codes.
6. Fill in the 'Send Report To' section with institution details, including fax number and contact person’s phone number.
7. Review all entered information for accuracy before submitting your form through our platform.

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