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Contract Code: Hospital Services: Patient Type: Hematology Visit Type: OutPatient 'Dept:'

Default Laboratory - Main Laboratory


Demon Street,Near S G Road NEW ORLEANS NEW YORK 123412345 Phone:(022) 475-4211 Fax:(000) 000-0123

Physician:

Patient:
ID:

Room No/Bed No:

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Accession 800096336 0800096336 Requisition #: 800096336 Southern Hospital Laboratory Doctor ID: 100 Account No: 100 NEW ORLEANS, Los Angeles, 70112 HIS ID: (221) 258-2589,(221) 258-2599 First Reported: 5/03/2012 @ 11:20 PM Test Name Result

FORD HARRISON

61539

X3,X3,X3
D.O.B.: 5/01/1992 20 YRS 2 DAYS Sex: M Male Phone: (000) 000-0000 Status: Final Report Units Normal Range Notes

Collected: 5/03/2012 @ Received: 5/03/2012 @ 11:16 PM Scheduled: 5/03/2012 @ 11:16 PM

Report Generated For :


Name: Phone: Hematology T

Department ID: MAIN

Copies: 1 Destination : Printer Address: CSZ:

HP Color LaserJet 9500 PCL 6

Other Tests

A1

5.00 Result Reporting|Telephone|Q| 5/03/2012 at 11:16 PM Called to __ by __ at 5/03/2012 / 11:16 PM Read Back by __; at 5/03/2012 / 11:16 PM

5.00 - 10.00

Received Specimens: Specimen G Received Date Topography Code Topography Description

5/03/2012

Medical Directors
Dr Philip Red Date Printed: 5/03/2012 11:20 PM >> PH- Panic High Dr James Smith Dr Methew Colletti > AH- Abnormal High Result Copied ~ AB-Abnormal *** Final Page ***

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