|Downtime form:||A-1a Doctor/Provider Orders - Pathology Core and Specialty Care Nursery|
|Red top tube 5 mL (Clot Activator)||Red top tube 5 mL (Clot Activator)|
Absolute Minimum: 3 mL in a red top tube
• Patient's name, gender and birthday
• Specimen collection date
• Referring clinic or physician name and contact information,
including fax number
• Clinical history and findings (attach clinical notes)
• Clearly marked name of test requested
Note: A specimen will not be processed without a fully completed requisition form.
Please print, complete, and submit the Ocular Immunology Laboratory, Oregon Health & Science University Test Requisition from Mayo Medical Laboratories with the specimen.