John Smith, MD

Family and General Medicine

1600 Creekside Dr., Suite 3300

Folsom, CA 95630

voice (916) 984-0000

fax (916) 983-0000

 

Unilab

1600 Creekside Dr., 1st floor

Folsom, CA 95630

(916) 984-8032

Mon-Fri 7 AM-5:30 PMSat 8 AM-1 PM

 

This is a lab request for

James, Patricia            dob 02/01/1926           76 & 3/12 y/o              4/9/02

941-0000                     ---             

 

fasting: 10 hrs, water and meds only for 10 hrs prior to lab test, appointment not needed

 

CBC ESR comp metabolic panel ("CMP"), TSH, UA, lipids

 

ICD # 784.0 

 

 

Thank you,

 

Electronic signature John Smith, MD

 

 

John Smith, MD