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Get and Sign HUMBOLDT DIABETES Lab Requisition PROJECT HDP#  Form

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HUMBOLDT DIABETES PROJECT Lab Requisition HDP 3100 Edgewood Road Eureka CA 95501 707 443-4553 Patient Name DOB Age Requesting Clinician Signature Responsible Party / Insured Name Sex Street Address Insurance Phone City hdp State Zip Bill Group Patient Labcorp Quest Diagnostics Fasting Non-Fasting Stat Routine PANELS Fax Send Duplicate report to Humboldt Diabetes Project - Fax 443-2527 Call and CHEMISTRY ICD-9 Code BASIC METABOLIC PANEL AMMONIA PROLACTIN COMP METABOLIC PANEL AMYLASE...
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