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SPECIAL REQUEST ORDER FORM All Orders must be faxed DO NOT USE THIS FORM FOR HLA/HPA SELECTED for IUTs USE FORM 1000101869 Request for HLA/HPA Selected PlateletsSECTION 1: TO BE COMPLETED BY HOSPITAL

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Identify the items you wish to request and gather necessary information.

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What is special request order form?

A special request order form is a document used to request specific approvals or exceptions related to certain regulatory or administrative requirements.

Who is required to file special request order form?

Individuals or entities seeking special considerations or exceptions from standard regulatory procedures are required to file a special request order form.

How to fill out special request order form?

To fill out a special request order form, provide the necessary personal or organizational information, clearly state the request being made, justify why the request should be granted, and submit any required supporting documentation.

What is the purpose of special request order form?

The purpose of the special request order form is to facilitate the process of requesting exceptions or approvals for specific cases that do not conform to standard rules or regulations.

What information must be reported on special request order form?

The information required on a special request order form typically includes the requester's contact information, details of the request, relevant dates, and any supporting documents or additional notes.

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