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3rd PARTY REQUISITION FORM INSTRUCTIONS 1. Please complete all highlighted areas in their entirety. P 866.358.9828 f 866.869.0148 2. Please provide all specimen information (draw date/time). Draw

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Lab use only refers to products or equipment that are intended for use in a laboratory setting and should not be used for any other purpose.

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Information that must be reported on lab use only includes the type of equipment or products being used, the quantity, the purpose of use, and any relevant safety precautions.

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