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Children S Hospital Los Angeles Chla  Form

Children S Hospital Los Angeles Chla Form

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COLLECTION INFORMATION Date Collected Mo/Day/Year Time Collected AM PM Specimen ID/Accession number DIRECTIONS AND STORAGE INSTRUCTIONS Samples must be received within 24 hours of collection. Blood collected in yellow top ACD tubes and red top tubes is stable at room temperature for 48 hours. Day Gender MI M F Unknown Race Phone Fax Ordering Physician PATIENT HISTORY AND CLINICAL INFORMATION Clinical Diagnosis ICD-9 Code Blood Group Address City State Zip Code Year MRN Contact Name A B AB ...
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