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Pqme5001 2026

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 and reasons for processing despite labeling issues. 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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Click ‘Get Form’ to open pqme5001 in the editor.
Begin by entering your first name and surname in the designated fields. Ensure accuracy for proper identification.
Input your date of birth (DOB) and location, including ward number or unit, to provide context for the request.
Fill in your hospital/NHS/A&E number along with the name of your consultant or GP to facilitate communication.
Record the date and time of collection, ensuring these details align with clinical requirements.
Provide clinical details and specify the investigations or tests required, including any relevant infection status.
Complete the signature field, print your name in capitals, and include a contact number for follow-up.
Clearly state the reasons why this sample cannot be repeated and must be processed within the re-test interval.
Finally, enter laboratory details such as specimen type and laboratory specimen numbers before submitting the form.

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