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Custom Printed Infectious Disease Requisition Form

This form is designed and printed to be used as an Infectious Disease Requisition, specifically SARS-CoV-2 Assay (COVID-19 Test). It is made with carbonless NCR paper and has multiple parts/copies. Note that we can edit and customize this format to make it more specific to what you need. There is also a set of numbered barcoded labels integrated with the form. The preprinted list of options selections makes it easy and efficient to fill out the form manually or by hand.

USAGE

  • Used to record and summarize laboratory testing
  • Show the name of the sample tested and testing results
  • Track all the points of contact of the sample collected from a patient, from the collection of the sample to analysis.

FEATURES

  • 3-Part carbonless form
  • Continuous form for prin feed or dot matrix printer
  • Consecutively numbered
  • Barcoded form and integrated label
  • The editable format can be customized to meet your needs

Size: 8 1/2 x 11" (9 1/2 x 11" with tracks on the sides)
Parts/Copies: Multi-part carbonless copies
 

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