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1. - HRLMP

Molecular Diagnostic Genetics Requisition McMaster University Medical Centre Molecular Genetics Laboratory, Room 2N22 1200 Main Street West, Hamilton, ON L8N 3Z5 Telephone: 905-521-2100 Fax: 905-521-7913 Email: 1. *Patient Last Name: *First Name: *DOB (DD/MM/YY) *SEX M F *Health Card No: *Mandatory Information (Specimen cannot be processed without this data) Test Requested: Please see the HRLMP Laboratory Test Information Guide for complete sample requirements and information Hemoglobinopathy Ethnicity.

Molecular Diagnostic Genetics Requisition McMaster University Medical Centre Molecular Genetics Laboratory, Room 2N22 1200 Main Street West, Hamilton, ON L8N 3Z5

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