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Innovative Diagnostics - NKF Collection Form
Please submit a separate request for each collection timing. Thank you.
NKF Dialysis Centre
*
Please select
NKF (ALJ DC)
NKF (AM1 DC)
NKF (AM2 DC)
NKF (AM3 DC)
NKF (BED DC)
NKF (BBK DC)
NKF (BPJ DC)
NKF (CLE DC)
NKF (GMH DC)
NKF (HON DC)
NKF (HG1 DC)
NKF (HG2 DC)
NKF (JW1 DC)
NKF (KKT DC)
NKF (PSR DC)
NKF (SRG DC)
NKF (SMI DC)
NKF (TM1 DC)
NKF (TM2 DC)
NKF (TWY DC)
NKF (TPH DC)
NKF (UBK DC)
NKF (WD1 DC)
NKF (WD2 DC)
NKF (YS1 DC)
DC Email
*
Name of requester
Date of specimen taken
DD
/
MM
/
YYYY
Time of specimen taken
Before 9am
Before 2pm
Before 5pm
Date for specimen to be picked up
DD
/
MM
/
YYYY
Sample to be collected for this round
NKF1*
Calcium*
Phosphate*
NKF2
NKF3
NKF4
NKF5
NKF6
NKF7
ALT
AST
CMVG
CMVM
HCV
HCVRNA
HepBs Ab
HepBs Ag
Full Liver Profile
Stool VRE
HIV PCR
Anti-HCV RIBA
FBC^
Vancomycin Trough^
Please note the following:
* Specimen will be collected as per requested timing
^ Specimen will be collected on the same day
All other specimens taken after 5pm will be collected on the following day
Any other test(s), please specify:
Any instructions:
Consumables
5 x Request forms (yellow)
5 x Request forms (green)
500 x Biohazard ziplock bags
30 x Red plastic bags
100 x Cable ties
Other consumables, please specify: