MICROBIOLOGY DX, INC.

19A CROSBY DRIVE, STE 215

BEDFORD, MA 01730

TEL: 781-276-4956 FAX: 781-276-6236

ORDER PAD - FORMS AND SUPPLIES

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Account Number:

Date:

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Item Description

Supplied

LAB REQUISITIONS

50

CYTOLOGY REQUISITIONS

50

AFP DATA SHEET

50

HIV CONSENT FORMS

50

TELEPHONE REPORT PADS

PAD/25

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