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R E Q U I S I T I O N F O R M I N T E R N AT I O N A L 0 9 0 5 2 0 2 2 Phone: +1 800.739.4137 | Fax: +1 800.893.0276 | support@tempus.com A. PATIENT INFORMATION (REQUIRED)B. ORDERING PHYSICIAN INFORMATION

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Access the tempusunlimited.org website

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