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Page 1 of 2 VANDERBILT UNIVERSITY MEDICAL CENTER REQUEST FOR BIOPSY CONSULTATION Agnes Fogo M. D. Director Director Division of Renal/Electron Microscopy Pathology Laboratory C2317 Medical Center North Nashville TN 37232-2561 Phone 615 322-3070 Fax 615 322-4840 PLEASE FILL IN ALL SPACES ACCURATELY TO INSURE PROPER HANDLING OF SPECIMEN Patient Name Age Date of Birth // Sex M/F Race SSN -- Medical Record In patient / out patient circle one Other m.

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