Universal Screening

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Universal Screening

Blood Specimen Delivery Checklist

TO : Obstetric Screening Lab., CUHK

FROM : KWH / PMH / PWH / UCH / TKOH (US1 / US2)

Please circle when appropriate

.

Specimen collection date : _____/_______/_________( AM /PM)

Please fill in date and circle session.

Please affix labels of patient on two separate sheets. One copy will be returned to referral hospital.

_________________________________________________________________________

For laboratory’s use:

Received by Obs Screening Laboratory

:

1/2

Universal Screening

Blood Specimen Delivery Checklist

TO : Obstetric Screening Lab., CUHK

FROM : KWH / PMH / PWH / UCH (US1 / US2)

Please circle when appropriate

.

Specimen collection date : _____/_______/_________( AM /PM)

Please fill in date and circle session.

Please affix labels of patient on two separate sheets. One copy will be returned to referral hospital.

_________________________________________________________________________

For laboratory’s use:

Received by Obs Screening Laboratory

2/2

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