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Pathology Requisition Notice

Dr. Grimes wrote a letter to Rajarajeshwari Kommu referring her for fasting blood tests at her local public hospital and included a laboratory requisition form. The form requests that blood tests be performed to monitor her hypothyroidism, including a full blood count, iron studies, ferritin, TSH, lipid profile, and Vitamin B12. The results are to be sent to Dr. Grimes or Dr. Sylvester Mooney at Dr. Grimes' address.

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101 views2 pages

Pathology Requisition Notice

Dr. Grimes wrote a letter to Rajarajeshwari Kommu referring her for fasting blood tests at her local public hospital and included a laboratory requisition form. The form requests that blood tests be performed to monitor her hypothyroidism, including a full blood count, iron studies, ferritin, TSH, lipid profile, and Vitamin B12. The results are to be sent to Dr. Grimes or Dr. Sylvester Mooney at Dr. Grimes' address.

Uploaded by

Rajarajeshwari Kommu
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Dr.

Seán Grimes
BSc MB BCh BAO PGDip MRCGP FRACGP
14A Knockmeenagh Road
Clondalkin, Dublin 22
tel: 01 459 5132
fax: 01 464 2916
Date: 14/12/2021
Consultation ID: 2021-12-14-TR1020811-AP283147

RAJARAJESHWARI KOMMU
1 WATERSIDE VIEW, WATERSIDE
MALAHIDE
CO. DUBLIN

PATHOLOGY REQUISITION FORM

Dear Rajarajeshwari ,

Please contact the blood testing section of your local public hospital and arrange an appointment for
'Fasting Bloods'

You must bring this letter with you when you attend the Hospital for these tests.

Yours sincerely

Dr. Grimes 424482

LABORATORY REQUISITION FORM

Re: RAJARAJESHWARI KOMMU

Date of Birth: 03/01/1997

Age: 24
Gender: Female

Address: 1 Waterside View, Waterside,

SPECIMEN TYPE: BLOOD

PLEASE PERFORM AND REPORT ON THE FOLLOWING INVESTIGATIONS:

FBC

Iron studies

Ferritin
TSH

Lipid profile

VitB12

CLINICAL NOTE:

Monitoring hypoothyroidism.

PLEASE SEND RESULTS TO ME AT MY ADDRESS AS DETAILED ABOVE OR TO DR


SYLVESTER MOONEY (MCN: 10015) AT THE SAME ADDRESS

Thank you.

Yours sincerely
Dr. Grimes 424482

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