URESA Request Form for
Schedule / Reschedule / Redraw (circle): M / Ch / AF other: _____ **LabCorp Case Number : _____ **Indicate previous LabCorp Case number if you need for us to reuse specimen on anyone from a previous case. Mother (always include the mom’s name unless she will not be tested. Indicate MNT if she is not to be tested.) ................
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