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COVID-19 and Respiratory Virus Test Requisition
Virus Test Requisition ALL Sections of this form must be completed at every visit For laboratory use only. Date received (yyyy/mm/dd): PHOL No.: 1 - Submitter Lab Number (if applicable): Ordering Clinician (required) Surname, First Name: OHIP/CPSO/Prof. License No: Name of clinic/ facility/health unit: Address: cc Hospital Lab (for entry into LIS)
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