This document is a laboratory requisition form from Health Diagnostic Laboratory Inc., directed by Dr. Joseph P. McConnell. It includes instructions for filling out patient information, specimen information, billing information, and a release and assignment of benefits section. The form lists various tests under categories such as Lipoprotein Particles & Apolipoproteins, Inflammation & Platelets, Myocardial Stress, Metabolic, Genetic Assays, Cancer Markers, Thyroid Function, and Routine Panels. Diagnosis codes for cardiovascular, endocrine, nutrition, metabolic, mental disorders, signs & symptoms, respiratory, gastrointestinal, blood disorders, and genitourinary conditions are provided. The form is signed by Dr. Peter Attia on June 5, 2015.
documents/EFTA00305909.pdf
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