Request Additional Testing for a Patient
Printer-friendly versionRequest Additional Testing for a Patient
Please copy and paste the required details below into an email and send to nvrl.admin@healthmail.ie
______________________________________________________________________________________________________________________________________
Request for additional testing for a patient
Requested by___________________________
Patient details
Name_________________________________
Date of birth____________________________
Hospital/Practice/Clinic name___________________________________
NVRL Lab number (if known) ________________________
Patient sample date________________________________
Clinician name___________________________
IMC number_____________________________
Contact number___________________________
Addtitional tests required
1.___________________________
2.___________________________
3.___________________________
Other________________________