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  • Duke Pathology Internal Clinical Trial Individual Pathology Materials Request Form

Get Duke Pathology Internal Clinical Trial Individual Pathology Materials Request Form

R Name Requestor Dept. Patient Name (last, first, middle) Date of birth (mm/dd/yyyy) Requestor Phone Requestor email Accession # Medical Record # Date of Surgery Written consent received date By submitting this form, you are acknowledging that you are authorized by the PI of this trial to request materials and/or services. Date picked up: Choose one: Your order will not be processed until written consent for participation is received. Please attach copy of written consent with your r.

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Professor of Pathology and Ophthalmology, and Residency Program Director Thomas J. Cummings, MD, lectured at the 12th Joint European Ophthalmic Pathology Society (EOPS) and Verhoeff-Zimmerman Society meeting held in Liverpool, England, from June 7-11, 2023.

Get Your Medical Records from Duke Health Email: ROI-Requestor3@dm.duke.edu. Fax: 919-620-5165. Mail: Release of Information. Duke University Health System. P.O. Box 3016. Durham, NC 27710. Customer Service: 919-684-1700. We are open Monday – Friday 8:00 am to 4:30 pm.

For more information on pathology consultations, preparation, submission, and turnaround time, please contact the Consultative Services office at 919-684-2860.

Duke University Medical Center is the name given to the group of patient care, education and medical research facilities on the medical campus of Duke University in Durham, North Carolina.

If you have a medical or patient-related concern, please contact the Duke Consultation and Referral Center at dukecons@notes.duke.edu or call 888-ASK-DUKE or 919-416-3853. Please do not send personal or medical information over the Web or via e-mail.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232