Upload
others
View
13
Download
0
Embed Size (px)
Citation preview
Conjugated Bilirubin
PA
TH
OL
OG
Y R
OU
TIN
E O
RD
ER
S
Hav
e yo
u la
bel
led
th
e S
amp
le &
Req
ues
t F
orm
Co
rrec
tly?
If D
etai
ls a
re m
issi
ng
th
is s
amp
le m
ay n
ot
be
pro
cess
ed.WV
G00
1R
ef-2
3266
TEA
R Bed Number (forPhlebotomy Collections)
Patient ID Checked Samples Collected
Date: Time:
CLINICAL DETAILS - WHAT QUESTIONS DO YOU WANT ANSWERED?
ETHNIC ORIGIN .................................................................
TREATMENTDate of onsetPregnant Y N Immunocompromised Y N
EDD Month Year Danger of Infection Y N
A S E P A R A T E S P E C I M E N I S R E Q U I R E D F O R E A C H B L O C K O F T E S T SChemical Pathology (SST Yellow Top)
Lipid profile
Total Cholesterol
Uric acid
Magnesium
Amylase
CRP
CK
Urine ACR
Glucose (Fluoride Grey Top)
Hb A1C (Purple Top EDTA)
Thyroid Profile
LH/FSH
Prolactin
Oestradiol
Testosterone
Progesterone
PSA
HCG
AFP
CEA
CA 125
CA 19.9
CA 15.3
(SST Yellow Top)
THIS REQUEST HAS “ROUTINE” PRIORITY
DOCTOR’S NAME (PRINT) ....................................... Bleep No. .........................
SIGNATURE .............................................................. Date .................................
Immunology (SST Yellow Top )
Rheumatoid Factor
Antinuclear antibodies
ds DNA Antibodies
ENA
ANCA
Thyroid antibodies
Gastric Parietal Cell Abs.
Liver Disease Autoantibodies
Coeliac Screen
Total IgE
Specific IgE (please specify)
Acetyl Choline Rec. Ab
Endocrine Ab. (please specify)
CSF Immunochemistry(CSF & SST Blood)
Virology (SST Yellow Top )Antenatal Screen
HIV
Syphilis - (screen only)
Pre Hep B. Vaccine
Post Hep B. Vaccine
Pre Hep A. Vaccine
Rubella screen non-pregnant
CMV IgG screen
VZV IgG screen
Toxoplasma IgG
Hep A IgM
Hep B surface Ag
Hep C IgG
Glandular fever(EBV, CMV, Toxo)
EBV
Mycoplasma IgM
Measles IgG
Mumps IgG
Virology (Purple Top EDTA)Viral Load
Specify Virus.........................
Haematology (Purple Top EDTA)
FBC (inc. WBC Differential)
Reticulocytes
Paul Bunnell
Haemoglobinopathy screen
ANC Screen
Partner
Preconception
G-6-PD Screen
ESR (Seditainer Black Top)
Haematinics (SST Yellow Top)Ferritin
Folate
Vitamin B12
Erythropoietin
Flowcytometry (Purple Top EDTA)
Harrison Wing profile
Lymphocyte sub-sets
Blood Transfusion (PINK Top EDTA)
Group & Save
Direct Antiglobulin
Kleihauer
Prophylactic Anti-D
Y N
Dose Given .......................................
Date Given ........................................
Group & Crossmatch
Date required ...................................
Time required ...................................
No. of units ......................................
Haemostasis
Coagulation screen(1 x Citrate Blue Top)
INR (warfarin)(1 x Citrate Blue Top)
D-Dimer(1 x Citrate Blue Top)
Thrombophilia screen(4 x Citrate Blue Top+
Antiphospholipid Anti(2 x Citrate Blue Top+
Anticoagulant Therapy
Yes No
Specify:
Other Tests or Blood Products (Please write clearly in CAPITA
PID NUMBER
SURNAME
FORENAME
DATE OF BIRT FH M
NHS NUMBER
GP ATTACH
ADDRESSOGRAPH
LABEL
REPORT DESTINATION
CONSULTANT/G.P.
SPECIALITY
Date & Time of receipt by Laboratory
CL
INIC
AL
LA
BO
RA
TO
RY
SE
RV
ICE
S
Ro
uti
ne
BLO
OD
Ord
ers
WV
G001
Re
f-2
32
66
TE
AR Bed Number (for
Phlebotomy Collections)Patient ID Checked andSamples Collected by:
Date: Time:
CLINICAL DETAILS - WHAT QUESTIONS DO YOU WANT ANSWERED?
ETHNIC ORIGIN .................................................................
TREATMENTDate of onsetPregnant Y N Immunocompromised Y N
EDD Month Year Danger of Infection Y N
A S E P A R A T E S P E C I M E N I S R E Q U I R E D F O R E A C H B L O C K O F T E S T SChemical Pathology (SST Yellow Top)
Full Lipid Profile
Total Cholesterol
Uric acid
Magnesium
Amylase
CRP
CK
Urine ACR
Glucose (Fluoride Grey Top)
Hb A1C (Purple Top EDTA)
Thyroid Profile
LH/FSH
Prolactin
Oestradiol
Testosterone
Progesterone
PSA
HCG
CA 125
Pro-BNP
(SST Yellow Top)
THIS REQUEST HAS “ROUTINE” PRIORITY
DOCTOR’S NAME (PRINT) ....................................... Bleep No. .........................
SIGNATURE .............................................................. Date .................................
Immunology (SST Yellow Top )
Immunology (SST Yellow Top )
Rheumatoid Factor
Antinuclear antibodies
ds DNA Antibodies
ENA
ANCA
Thyroid antibodies
Gastric Parietal Cell Abs.
Liver Disease Autoantibodies
Coeliac Screen
Total IgE
Specific IgE (please specify)
Acetyl Choline Rec. Ab
Endocrine
(Sample to Lab in 2 hours)
ADR, DABS
(CH100, AGP)
Ab. (please specify)
Virology (SST Yellow Top )Antenatal Screen
HIV
Syphilis - (screen only)
Pre Hep B. Vaccine
Post Hep B. Vaccine
Pre Hep A. Vaccine
Rubella screen non-pregnant
CMV IgG screen
VZV IgG screen
Toxoplasma IgG
Hep A IgM
Hep B surface Ag
Hep C IgG
Glandular fever(EBV, CMV, Toxo)
EBV
Mycoplasma IgM
Measles IgG
Mumps
Viral Rash Investigations
IgG
Virology (Purple Top EDTA)Viral Load
Specify Virus.........................
Haematology (Purple Top EDTA)
ESR
Haematinics
(SST Yellow Top)
Flowcytometry (Purple Top EDTA)
Harrison Wing profile
Lymphocyte sub-sets
Blood Transfusion (PINK Top EDTA)
Group & Save
Direct Antiglobulin
Kleihauer
Prophylactic Anti-D
Y N
Dose Given .......................................
Date Given ........................................
Group & Crossmatch
Date required ...................................
Time required ...................................
No. of units ......................................
Haemostasis + ThrombosisCoagulation screen (INR & APTT)(1 x Citrate Blue Top)
INR (warfarin)(1 x Citrate Blue Top)
D-Dimer(1 x Citrate Blue Top)
Thrombophilia screen inc APA profile(4 x Citrate Blue Top+ 1 SST Yellow Top)
Antiphospholipid Antibogy Profile Only(2 x Citrate Blue Top+ 1 SST Yellow Top)
Special Coagulation screen(INR, APTT, Fibinogen) (1xcitrate blue top)
Anticoagulant Therapy
Yes No
Specify:
Other Tests or Blood Products (Please write clearly in CAPITAL Letters,Do NOT use abbreviations:)
PID NUMBER
SURNAME
FORENAME
DATE OF BIRT FH M
NHS NUMBER
GP ATTACH
ADDRESSOGRAPH
LABEL
REPORT DESTINATION
CONSULTANT/G.P.
SPECIALITY
Date & Time of receipt by Laboratory
BR
BLVR
BCBIL
BBN
BLPD
BTCHOL
BUA
BMGN
BAMY
BCRP
BCK
IRON BIRON
UACR
BTSH
BU
BGTROPH
BPROL
BE2
BTET
BPROG
BPSA
BHCG
BC125
BBNP
Troponin BTROP
C3C4 C34
RFWP
HEP2
DNAWP
ENID
ANCAS
THYR
AIP
AIP
COELWP
RIST
ACH
BGParathyroid Hormone BPTH(Sample to Lab in 2 hours)
LU
BHA1C
ANCS
HIV
SYGA
HBCA
HAVG
RUBS
CMVG
VZG
TOXG
HAVM
HBS
HEPC
GFS
EBV
ESR
Erythropoietin
Methylmelanonic Acid (BMMA)
EPO
Ferritin
Folate
Vitamin B12
25 hydroxy Vitamin D
FERR
SFOL A
B25D
SS
VB12
T4T8+FBC
LSS+FBC
GS
BDAGT
KLEI
GS+EI
MYCOM
MEAG
MUMPG
HBSA
FBC (inc. WBC Differential)
Reticulocytes
Paul Bunnell
Haemoglobinopathy screen
ANC Screen
Partner
Preconception
G-6-PD Screen
FBC
RETICS+FBC
PBT+FBC+FILM
FBC+G-6-PD
FBC+MPI+FILM(please mark clearly as URGENT)
FBC+SICK
Urea
Renal Profile Malaria Studies
Liver Profile
Bone Profile
Complement activity
Conjugated Bilirubin
PA
TH
OL
OG
Y R
OU
TIN
E O
RD
ER
S
Hav
e yo
u la
bel
led
th
e S
amp
le &
Req
ues
t F
orm
Co
rrec
tly?
If D
etai
ls a
re m
issi
ng
th
is s
amp
le m
ay n
ot
be
pro
cess
ed.WV
G00
1R
ef-2
3266
TEA
R Bed Number (forPhlebotomy Collections)
Patient ID Checked Samples Collected
Date: Time:
CLINICAL DETAILS - WHAT QUESTIONS DO YOU WANT ANSWERED?
ETHNIC ORIGIN .................................................................
TREATMENTDate of onsetPregnant Y N Immunocompromised Y N
EDD Month Year Danger of Infection Y N
A S E P A R A T E S P E C I M E N I S R E Q U I R E D F O R E A C H B L O C K O F T E S T SChemical Pathology (SST Yellow Top)
Lipid profile
Total Cholesterol
Uric acid
Magnesium
Amylase
CRP
CK
Urine ACR
Glucose (Fluoride Grey Top)
Hb A1C (Purple Top EDTA)
Thyroid Profile
LH/FSH
Prolactin
Oestradiol
Testosterone
Progesterone
PSA
HCG
AFP
CEA
CA 125
CA 19.9
CA 15.3
(SST Yellow Top)
THIS REQUEST HAS “ROUTINE” PRIORITY
DOCTOR’S NAME (PRINT) ....................................... Bleep No. .........................
SIGNATURE .............................................................. Date .................................
Immunology (SST Yellow Top )
Rheumatoid Factor
Antinuclear antibodies
ds DNA Antibodies
ENA
ANCA
Thyroid antibodies
Gastric Parietal Cell Abs.
Liver Disease Autoantibodies
Coeliac Screen
Total IgE
Specific IgE (please specify)
Acetyl Choline Rec. Ab
Endocrine Ab. (please specify)
CSF Immunochemistry(CSF & SST Blood)
Virology (SST Yellow Top )Antenatal Screen
HIV
Syphilis - (screen only)
Pre Hep B. Vaccine
Post Hep B. Vaccine
Pre Hep A. Vaccine
Rubella screen non-pregnant
CMV IgG screen
VZV IgG screen
Toxoplasma IgG
Hep A IgM
Hep B surface Ag
Hep C IgG
Glandular fever(EBV, CMV, Toxo)
EBV
Mycoplasma IgM
Measles IgG
Mumps IgG
Virology (Purple Top EDTA)Viral Load
Specify Virus.........................
Haematology (Purple Top EDTA)
FBC (inc. WBC Differential)
Reticulocytes
Paul Bunnell
Haemoglobinopathy screen
ANC Screen
Partner
Preconception
G-6-PD Screen
ESR (Seditainer Black Top)
Haematinics (SST Yellow Top)Ferritin
Folate
Vitamin B12
Erythropoietin
Flowcytometry (Purple Top EDTA)
Harrison Wing profile
Lymphocyte sub-sets
Blood Transfusion (PINK Top EDTA)
Group & Save
Direct Antiglobulin
Kleihauer
Prophylactic Anti-D
Y N
Dose Given .......................................
Date Given ........................................
Group & Crossmatch
Date required ...................................
Time required ...................................
No. of units ......................................
Haemostasis
Coagulation screen(1 x Citrate Blue Top)
INR (warfarin)(1 x Citrate Blue Top)
D-Dimer(1 x Citrate Blue Top)
Thrombophilia screen(4 x Citrate Blue Top+
Antiphospholipid Anti(2 x Citrate Blue Top+
Anticoagulant Therapy
Yes No
Specify:
Other Tests or Blood Products (Please write clearly in CAPITA
PID NUMBER
SURNAME
FORENAME
DATE OF BIRT FH M
NHS NUMBER
GP ATTACH
ADDRESSOGRAPH
LABEL
REPORT DESTINATION
CONSULTANT/G.P.
SPECIALITY
Date & Time of receipt by Laboratory
CL
INIC
AL
LA
BO
RA
TO
RY
SE
RV
ICE
S
Ro
uti
ne
BLO
OD
Ord
ers
WV
G001
Re
f-2
32
66
TE
AR Bed Number (for
Phlebotomy Collections)Patient ID Checked andSamples Collected by:
Date: Time:
CLINICAL DETAILS - WHAT QUESTIONS DO YOU WANT ANSWERED?
ETHNIC ORIGIN .................................................................
TREATMENTDate of onsetPregnant Y N Immunocompromised Y N
EDD Month Year Danger of Infection Y N
A S E P A R A T E S P E C I M E N I S R E Q U I R E D F O R E A C H B L O C K O F T E S T SChemical Pathology (SST Yellow Top)
Full Lipid Profile
Total Cholesterol
Uric acid
Magnesium
Amylase
CRP
CK
Urine ACR
Glucose (Fluoride Grey Top)
Hb A1C (Purple Top EDTA)
Thyroid Profile
LH/FSH
Prolactin
Oestradiol
Testosterone
Progesterone
PSA
HCG
CA 125
Pro-BNP
(SST Yellow Top)
THIS REQUEST HAS “ROUTINE” PRIORITY
DOCTOR’S NAME (PRINT) ....................................... Bleep No. .........................
SIGNATURE .............................................................. Date .................................
Immunology (SST Yellow Top )
Immunology (SST Yellow Top )
Rheumatoid Factor
Antinuclear antibodies
ds DNA Antibodies
ENA
ANCA
Thyroid antibodies
Gastric Parietal Cell Abs.
Liver Disease Autoantibodies
Coeliac Screen
Total IgE
Specific IgE (please specify)
Acetyl Choline Rec. Ab
Endocrine
(Sample to Lab in 2 hours)
ADR, DABS
(CH100, AGP)
Ab. (please specify)
Virology (SST Yellow Top )Antenatal Screen
HIV
Syphilis - (screen only)
Pre Hep B. Vaccine
Post Hep B. Vaccine
Pre Hep A. Vaccine
Rubella screen non-pregnant
CMV IgG screen
VZV IgG screen
Toxoplasma IgG
Hep A IgM
Hep B surface Ag
Hep C IgG
Glandular fever(EBV, CMV, Toxo)
EBV
Mycoplasma IgM
Measles IgG
Mumps
Viral Rash Investigations
IgG
Virology (Purple Top EDTA)Viral Load
Specify Virus.........................
Haematology (Purple Top EDTA)
ESR
Haematinics
(SST Yellow Top)
Flowcytometry (Purple Top EDTA)
Harrison Wing profile
Lymphocyte sub-sets
Blood Transfusion (PINK Top EDTA)
Group & Save
Direct Antiglobulin
Kleihauer
Prophylactic Anti-D
Y N
Dose Given .......................................
Date Given ........................................
Group & Crossmatch
Date required ...................................
Time required ...................................
No. of units ......................................
Haemostasis + ThrombosisCoagulation screen (INR & APTT)(1 x Citrate Blue Top)
INR (warfarin)(1 x Citrate Blue Top)
D-Dimer(1 x Citrate Blue Top)
Thrombophilia screen inc APA profile(4 x Citrate Blue Top+ 1 SST Yellow Top)
Antiphospholipid Antibogy Profile Only(2 x Citrate Blue Top+ 1 SST Yellow Top)
Special Coagulation screen(INR, APTT, Fibinogen) (1xcitrate blue top)
Anticoagulant Therapy
Yes No
Specify:
Other Tests or Blood Products (Please write clearly in CAPITAL Letters,Do NOT use abbreviations:)
PID NUMBER
SURNAME
FORENAME
DATE OF BIRT FH M
NHS NUMBER
GP ATTACH
ADDRESSOGRAPH
LABEL
REPORT DESTINATION
CONSULTANT/G.P.
SPECIALITY
Date & Time of receipt by Laboratory
BR
BLVR
BCBIL
BBN
BLPD
BTCHOL
BUA
BMGN
BAMY
BCRP
BCK
IRON BIRON
UACR
BTSH
BU
BGTROPH
BPROL
BE2
BTET
BPROG
BPSA
BHCG
BC125
BBNP
Troponin BTROP
C3C4 C34
RFWP
HEP2
DNAWP
ENID
ANCAS
THYR
AIP
AIP
COELWP
RIST
ACH
BGParathyroid Hormone BPTH(Sample to Lab in 2 hours)
LU
BHA1C
ANCS
HIV
SYGA
HBCA
HAVG
RUBS
CMVG
VZG
TOXG
HAVM
HBS
HEPC
GFS
EBV
ESR
Erythropoietin
Methylmelanonic Acid (BMMA)
EPO
Ferritin
Folate
Vitamin B12
25 hydroxy Vitamin D
FERR
SFOL A
B25D
SS
VB12
T4T8+FBC
LSS+FBC
GS
BDAGT
KLEI
GS+EI
MYCOM
MEAG
MUMPG
HBSA
FBC (inc. WBC Differential)
Reticulocytes
Paul Bunnell
Haemoglobinopathy screen
ANC Screen
Partner
Preconception
G-6-PD Screen
FBC
RETICS+FBC
PBT+FBC+FILM
FBC+G-6-PD
FBC+MPI+FILM(please mark clearly as URGENT)
FBC+SICK
Urea
Renal Profile Malaria Studies
Liver Profile
Bone Profile
Complement activity
Gu
y's
and
St
Th
om
as’ H
osp
ital
sL
abo
rato
ry S
ervi
ces
Imp
ort
ant
info
rmat
ion
fo
r al
l D
oct
ors
Ph
leb
oto
my
Ser
vice
St
Tho
mas
’ Ho
spita
l:E
xt 8
4778
Ble
ep 0
368
Guy
’s H
osp
ital:
Ext
847
87B
leep
133
2
Urg
ent
Sam
ple
s -
DO
NO
TU
SE
TH
IS F
OR
MU
se th
e ap
prop
riate
Em
erge
ncy
Inve
stig
atio
n Fo
rm fo
r ea
ch la
bora
tory
dis
cipl
ine
Sen
d s
amp
le d
irect
ly t
o a
pp
rop
riate
lab
ora
tory
PLA
CE
SP
EC
IME
N I
N B
AG
RE
MO
VE C
OVE
RIN
G S
TRIP
FO
LD T
OP
OVE
R T
O S
EA
L
Ou
t-o
f-H
ou
rs L
abo
rato
ry S
ervi
ceB
leep
Nu
mb
ers:
St.
Th
om
as’
Gu
y’s
Che
mic
al P
atho
log
y04
09C
ont
act
STH
Hae
mat
olo
gy
& B
loo
d T
rans
fusi
on
0201
1190
Hae
mo
stas
is20
05C
ont
act
STH
Mic
rob
iolo
gy
1802
Co
ntac
t S
THV
irolo
gy
Sw
itchb
oar
dS
witc
hbo
ard
Blo
od
Tra
nsf
usi
on
Ser
vice
Ple
ase
stat
e d
ate
and
tim
e b
loo
d is
req
uire
d.
Blo
od w
ill n
ot b
e is
sued
unl
ess
sam
ples
and
form
s co
mpl
y w
ith P
ID r
equi
rem
ents
.R
out
inel
y, b
loo
d c
an b
e cr
oss
mat
ched
and
issu
ed w
ithin
4 h
our
s o
f rec
eip
t o
f sam
ple
in t
he la
bo
rato
ry.
Co
ntac
t B
loo
d B
ank
Lab
ora
tory
for
all B
loo
d P
rod
ucts
.P
atie
nt d
etai
lsM
US
Tb
eha
ndw
ritte
n;ad
dre
sso
gra
ph
lab
els
mus
t no
tbe
used
.P
leas
e re
fer
to G
ST
T B
loo
d T
rans
fusi
on
Po
licy
for
mo
re in
form
atio
n.
Res
ult
s an
d A
dvi
ce S
ervi
ce
In a
dd
itio
n to
the
prin
ted
rep
ort
res
ults
are
ava
ilab
le fo
r al
l lab
ora
torie
s th
roug
h:
Guy
’s a
nd S
t T
hom
as’ H
osp
ital E
PR
Co
mp
uter
GP
ser
vice
s vi
a E
lect
roni
c M
ailin
g (
cont
act
lab
ora
tory
for
furt
her
info
rmat
ion)
Tele
pho
ne E
nqui
ries
bet
wee
n 9.
00 a
m a
nd 5
.00
pm
to
:E
xt
8800
8 fo
r Tr
ust
clie
nts
(020
) 71
88 8
008
for
exte
rnal
clie
nts
Hae
mo
stas
is fr
om
8.0
0 am
to
8.0
0 p
mLa
bo
rato
ry r
esul
ts e
xt.
8277
9 at
ST
H,
or
ext.
8909
5 at
GH
Clin
ical
Ad
vice
: ex
t 82
781
at S
TH
Pat
ien
t an
d S
amp
le I
den
tifi
cati
on
Cri
teri
aA
ll re
qu
ests
for
lab
ora
tory
inve
stig
atio
ns M
US
Tg
ive:
Fo
rmS
amp
leP
ID N
umb
erYe
sYe
sS
urna
me
and
Fo
rena
me
Yes
Yes
Dat
e o
f Birt
Yh
esYe
sS
eY
xes
Yes
Co
nsul
tant
and
Sp
ecia
lity
cod
esYe
sD
estin
atio
n fo
r re
po
rt c
od
eYe
sD
ate
of s
amp
leYe
sYe
sTi
me
of s
amp
leYe
s
Req
uest
s to
Blo
od
Tra
nsfu
sio
n: P
atie
nt d
etai
ls M
US
Tb
e ha
ndw
ritte
n; a
dd
ress
og
rap
h la
bel
s m
ust
not
be
used
.Fai
lure
to
co
mp
ly w
ill i
ncu
r d
elay
an
d/o
r re
ject
ion
of
the
sam
ple
Un
der
fill
ed t
ub
es m
ay n
ot
be
pro
cess
ed
Gu
y's a
nd
St
Th
om
as’
Ho
sp
ital
Lab
ora
tory
Se
rvic
es
Imp
ort
an
t U
se
r In
form
ati
on
Ph
leb
oto
my
Se
rvic
eS
t T
ho
mas’
Ho
spita
l:E
xt 8
47
78
Gu
y’s
Eve
lina C
hild
ren
’s H
osp
ital -
Ext
84
77
8 -
Sp
eci
alis
t P
aed
iatr
ic S
erv
ices
- fo
r all
child
ren
belo
w t
he a
ge o
f 1
6 y
ears
.
Ho
spita
l:E
xt 8
47
87
Use
the
app
rop
riate
Em
erg
ency
Inve
stig
atio
n Fo
rm fo
r ea
ch la
bo
rato
ry d
isci
plin
eS
en
d s
am
ple
dir
ect
ly t
o a
pp
rop
riate
lab
ora
tory
PLA
CE
SP
EC
IME
N I
N B
AG
RE
MO
VE
CO
VE
RIN
G S
TR
IP
FO
LD
TO
P O
VE
R T
O S
EA
L
Ou
t-o
f-H
ou
rs L
ab
ora
tory
Se
rvic
eB
lee
p N
um
be
rs:
St.
Th
om
as’
Gu
y’s
Ch
em
istr
y0
40
9C
on
tact
ST
HH
aem
ato
log
y &
Blo
od
Tra
nsf
usi
on
02
01
11
90
Haem
ost
asi
s +
Th
rom
bo
sis
20
05
Co
nta
ct S
TH
Mic
rob
iolo
gy
18
02
Co
nta
ct S
TH
Vir
olo
gy
Sw
itch
bo
ard
Sw
itch
bo
ard
Re
sult
s w
ill b
e a
vaila
ble
fro
m t
he
Tru
st’s
Re
sult
Re
po
rtin
g s
yste
m +
EP
R
Blo
od
Tra
nsfu
sio
n S
erv
ice
Ple
ase
sta
te d
ate
an
d t
ime b
loo
d is
req
uir
ed
.B
loo
d w
ill n
ot b
e is
sued
unle
sssa
mp
les
and
form
s co
mp
ly w
ith P
ID r
equire
men
ts.
Ro
utin
ely
, b
loo
d c
an
be c
ross
matc
hed
an
d is
sued
with
in 4
ho
urs
of
rece
ipt
of
sam
ple
in t
he la
bo
rato
ry.
Co
nta
ct B
loo
d B
an
k La
bo
rato
ry f
or
all
Blo
od
Pro
du
cts.
Patie
nt
deta
ilsM
US
Tb
eh
an
dw
ritt
en
;ad
dre
sso
gra
ph
lab
els
mu
st n
otb
eu
sed
.P
lease
refe
r to
GS
TT
Blo
od
Tra
nsf
usi
on
Po
licy
for
mo
re in
form
atio
n.
Re
su
lts a
nd
Ad
vice
Se
rvic
e
In a
dd
itio
n t
o t
he p
rin
ted
rep
ort
resu
lts a
re a
vaila
ble
fo
r all
lab
ora
tori
es
thro
ug
h:
Gu
y’s
an
d S
t T
ho
mas’
Ho
spita
l EP
R C
om
pu
ter
+ R
RS
GP
serv
ices
via E
lect
ron
ic M
aili
ng
(co
nta
ct la
bo
rato
ry f
or
furt
her
info
rmatio
n)
Tele
ph
on
e E
nq
uir
ies
betw
een
9.0
0 a
m a
nd
5.0
0 p
m t
o:
Ext
8
80
08
fo
r Tr
ust
clie
nts
(02
0)
71
88
80
08
fo
r ext
ern
al c
lien
tsH
aem
ost
asi
s +
Th
rom
bo
sis
fro
m 8
am
to
8p
m S
TH
an
d 8
am
to
5p
m a
t G
HLa
bo
rato
ry r
esu
lts e
xt.
82
79
9 a
t S
TH
, o
r ext
. 8
90
95
at
GH
Clin
ical A
dvi
ce:
ext
82
78
1 a
t S
TH
Pati
en
t an
d S
am
ple
Id
en
tifi
cati
on
Cri
teri
aA
ll r
eq
ue
sts
for
lab
ora
tory
inve
stig
atio
ns
MU
ST
giv
e:
Fo
rmS
am
ple
PID
Nu
mb
er
Yes
Yes
Su
rnam
e a
nd
Fo
ren
am
eYe
sYe
sD
ate
of
Bir
thYe
sYe
sS
ex
Yes
Yes
Co
nsu
ltan
t an
d S
peci
alit
y co
des
Yes
Dest
inatio
n f
or
rep
ort
co
de
Yes
Date
of
sam
ple
Yes
Yes
Tim
e o
f sa
mp
leYe
s
Req
uest
s to
Blo
od
Tra
nsfu
sion:
Pat
ient
det
ails
MU
ST
be
hand
writ
ten;
ad
dre
ssog
rap
h la
bel
s m
ust n
ot b
e us
ed
Failu
re t
o c
om
ply
will
incu
r d
ela
y an
d/o
r re
jecti
on
of
the
sam
ple
Un
de
r fi
lle
d
Fo
r m
inim
um
vo
lum
es &
sam
ple
re
qu
ire
me
nts
- p
lease
re
fer
to w
eb
sit
e:
ww
w.v
iap
ath
.co
.uk
tub
es m
ay
no
t b
e p
roce
sse
d
Urg
en
t S
am
ple
s -
DO
NO
TU
SE
TH
IS F
OR
M