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Get Lifelabs Genetics Hereditary Cancer Genetic Testing & Counselling Requisition 2019

Rio): Physician MSC# (British Columbia): Other Provinces (Ontario Voyager): 999 Ordering Physician Name Name Ordering Physician Address & contact info: Address Tel: Clear Form LifeLabs Demographic Label Additional Label (if needed) Fax: Confirmation of patient consent: I confirm that this patient has given consent to testing as may be required by applicable law. I have provided the patient with the Patient Information form and the opportunity for pre-test counselling, where details assoc.

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