Transcription of Maternal Prenatal Screen Requisition
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Maternal Prenatal Screen Requisition
Accession # Maternal Prenatal Screen Laboratory Services Client Response Centre 780-407-7484. Requisition Alberta Health Services, Edmonton and Area Personal Health Number (First or Second Trimester Screen ) DynaLIFEDX Diagnostic Laboratory Services M Patient Legal Name (Last) (First) (Initial) D dd Mon yyyy Copy to O. F B Name _____. Address City Prov. Postal Code Physician Code _____. Address _____. Chart # Patient Phone # Lab # _____. Bill Type CPL Alberta Health Care Ordering Physician/Practitioner Physician Code Specimen Event Type OR. IA AUXILLARY. IP IN PT CO Company XX Pre-paid Ordering Address / Location Report Location Code OP OUT PT. OT Out of Prov PB Patient Bill AP AMBUL. HC HMCARE Co. name _____. ST STAFF. Report address if different EN ENVIRON Address _____. WCB WORKER'S Client # _____. COMP. Date specimen Col. Location Time (24 h) Collector dd Mon yyyy Check Test Requested First Trimester (11w, 2d 13w, 6d, Gestational Age) Second Trimester (15w, 0d 20w, 6d Gestational Age).
Personal Health Number Accession # Maternal Prenatal Screen Requisition (First or Second Trimester Screen) Laboratory Services Client Response Centre 780-407-7484 Alberta Health Services, Edmonton and Area
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