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Get PA FRAT RI-FMS-0019 2024

PLEASE NOTE: PATIENTS MUST NOT TAKE FOLINIC ACID OR 5-MTHF FOR 48 HOURS PRIOR TO BLOOD DRAW. Specimen Type: Serum (SST serum separator collection tube) Date Specimen Collected: Diagnosis: Time Specimen Collected: Diagnosis Code(s): Preferred Method for Receiving Results: Email Fax Portal Other: FACILITY INFORMATION Provider Name: Facility Name: NPI #: Street Address: Telephone: Secure Fax: Email: City: State/Region.

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