Patient Instructions (Ctrl-P or Cmd-P to print)
Location
RCH
Burnaby
//calendar
Date Ordered
Date Required
Date Received
Sex
Surname, First Name
Address
City
Home Phone
Date of Birth (dd/mm/yy)
Work Phone
Medical Plan Number
WCB / ICBC Claim Number
MSP
WSBC
ICBC
Patient
Other:
"Electronically Signed"
Subject: