Laboratory test requisition form

Central Hospital of Vaasa

Clinical Laboratory

Referrer information
Physician/Department  
Institution Vaasa Central Hospital
Clinical Laboratory
Address Sandviksgatan 2 - 4
Zip + City FI65130  VAASA
Country Finland
Phone / Fax phone: +358 6 323 2520

fax: +358 6 323 2508
E-mail vks-laboratorio@vshp.fi
Billing + results are to be sent to:
Institution  
Address  
Zip + City  
Country  
Phone / Fax  
E-mail  
Receiving Laboratory Information
Receiver  
Institution  
Address  
Zip + City  
Country  
Patient + sample information
Sample Id  
Sampling time  
Patient name  
Date of Birth  

Reason(s) for test:

 

Test(s) requested