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PT NAME *ORDERS* MR # *ORDERS* Use Black or Blue Ball Point Pen All Entries Must Be Dated and Signed This is not a consultation from Infectious Diseases and does not substitute for one when indicated.
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Use black or blue ink when filling out the form.
Anyone who needs to submit the form is required to use black or blue ink.
You can fill out the form by using a black or blue pen and following the instructions provided.
Using black or blue ink ensures that the information on the form is easily readable and can be processed efficiently.
All relevant information pertaining to the form must be accurately reported using black or blue ink.
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