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RUHSCHSPHOther___DEPARTMENTOFPATHOLOGY&LABORATORYMEDICINEMOLECULARMICROBIOLOGY/VIROLOGYREQUISITION Patentable NAME:___ HAN:___Chart#:___ D.O.B.:___MF Ward/Location:___ Requesting physician:___ (Firstandlastname) Copyofreportto:_________ PleasesubmitaSEPARATEREQUISITIONforeachSPECIMENTYPE

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Department of Pathology and is a department within a medical facility that is responsible for the diagnosis of diseases through the examination of bodily tissues and fluids.

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