FRM/
Hospital Name | | |
|PULSE code | |
|Laboratory Manager Details |
|Full Name | |
|Telephone | |
|Email | |
|Laboratory IT Manager Details |
|Full Name | |
|Telephone | |
|Email | |
|Laboratory Information System (LIMS ) & Version |
|LIMS: |Version: |
|Please confirm Electronic Despatch Note (EDN) functionality with your LIMS supplier prior to submitting this request. |
|Print Name Dated |
|NHSBT Use Only |
|Request Submitted to Service Desk |Submitted by: |
| |Date: |
| |Log Number: |
|Account Details Received from Service Desk |Received by: |
| |Date: |
|PULSE Enabled |Enabled by: |
| |Date: |
|Customer Informed |Informed by: |
| |Date: |
| |
|Please return completed form electronically to: NHSBT.customerservice@nhsbt.nhs.uk |
| |
|OR Post to: Customer Service, NHS Blood and Transplant, Part Academic Block - Level 2, John Radcliffe Hospital, Headley Way – Headington, |
|Oxford, OX3 9BQ |
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