Fadel, Therese Birth date 15/05/1970 #58528 Page 1/1

Apr 24, 2023 2010 Laboratory RZ

Fasting for 8 hours Fasting for 12 hours If neither box is checked, fasting is NOT required for your blood work
Laboratory Use Only

** Fasting = Nothing to eat or drink except water and medication

Name
Raziya Zakeriya
Address

P.O. Box 91569, RPO Mer Bleu,

Orleans, ON, K1W 0A6
613 841-7009

031487 98499 ON 3147 461 002 TX 1970 05 15

514 869-6345

Fadel

Therese

Last Name: First Name

739 Decoeur Drive
Address Orleans, ON
K4A 1H2

Laboratory Use Only

24/04/2023

PS Suite® EMR report Printed by RZ on Apr 24, 2023 10:04

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