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United kingdom declaration form

Pqme5001 2025

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The document is a declaration form from the Leeds Teaching Hospitals NHS Trust, specifically for cases where a request form or specimen is inadequately labeled or falls within a re-test interval. It outlines the necessary information required to process such samples, including patient details, reasons for processing despite labeling issues, and laboratory specifics. The form emphasizes that clinical responsibility lies with the requester and provides instructions for returning the completed form to relevant laboratories.

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