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Children S Hospital Los Angeles 2016-2023
Ship paraffin blocks. MS 43 Los Angeles CA 90027 Phone 323-361-2469 Fax 323-361-8004 CONSULTATION REQUEST FORM Please use one form per case to include 1 Cover letter containing a summary of the clinical history 2 A copy of the surgical pathology report even if incomplete Referring Facility Date Ordering Physician Name Signature Phone Fax Address Contact Name Email MATERIAL SUBMITTED The information in this section is mandatory....
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