LabCorp - Request A Test

LabCorp

Laboratory Corporation of America

Specimen Number

Patient ID

Patient Last Name

Patient First Name

Patient Middle Name

Patient SS#

Patient Phone

Total Volume

Age (Y/M/D)

Date of Birth

Sex

Fasting

Patient Address

Control Number

Account Number

Phone:

Account Phone Number

Account Address

Route

Additional Information

Date and Time Collected

Date Entered

Date and Time Reported

Physician Name

NPI

Physician ID

Tests Ordered

Ariinttc1ear Antibodies, !FA; Drawing Fee

I

TESTS

Antinuclear Antibodies, IFA

RESULT

Negative

FLAG

UNITS

REFERENCE INTERVAL LAB

01 Negative 1:80

FINAL REPORT

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