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Get MDL Surgical Pathology Gynecology Test Requisition 2018-2024

Ogy: Gynecology Test Requisition Form Ordering Physician/Laboratory (Required: Include the ordering physician s first & last name, NPI, practice name, complete address, phone number and fax number.) Collector signature: Specimen Collection Information Number of specimen vials submitted: Date collected (required): Site A B Cervical POC Endocervical Vaginal Endometrial Vulvar IUD Other: Labial Biopsy Cone Curet.

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