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Get UI Health Care Microbiology Laboratory Requisition 2020

Ns Drive, 5231 RCP Iowa City, Iowa 52242 Toll Free: 866-844-2522 Local: 319-384-7212 Client Services Fax: 319-384-7213 Billing Fax: 319-356-0729 PATH# Completed by: PART A PATIENT INFORMATION Required Patient Last Name: Patient First Name: Street: City: St: Zip: Phone: Fax: Date of Birth: Gender: M F PART B PROVIDER INFORMATION Required Referring Institution: Street: City: St: Zip: Phone: Fax: Referring Physician: Referring Physician Phone: PART C - SPECIMEN INFORMATI.

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