Request 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________________________