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Liverpool Women's Hospital  

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Please complete all elements of the request card.Affixing a self-adhesive label containing patient information is acceptable.
To avoid unnecessary follow-up calls for missing information, please ensure that the following minimum data is provided.

  • Patient's First Name
  • Patient's Last Name
  • Date of Birth
  • Address (inc Postcode)
  • Unit No./ NHS No.
  • Clinical Information
  • Test(s) required
  • Referring Consultant
  • Referring Unit details
  • Date of sampling
  • Indication if consent to store DNA is
        declined.

    • Revised 21.06.04 (Alan Clark), Reviewed 18.05.05 (Alan Clark). Authorised 18.05.05 (Roger Mountford).