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