This is our product request order form. Received via air tube and product dispatched via same. [TABLE=class: MsoNormalTable, align: left] [TR] [TD=width: 379]Patient Name / DOB / Hospital or HC number / Ward / Special Requirements [/TD] [TD=width: 216, colspan: 2]Product Required [/TD] [/TR] [TR] [TD=width: 379, bgcolor: transparent] [/TD] [TD=width: 216, bgcolor: transparent, colspan: 2]Red Cells [/TD] [/TR] [TR] [TD=width: 216, bgcolor: transparent, colspan: 2]Fresh Frozen Plasma [/TD] [/TR] [TR] [TD=width: 216, bgcolor: transparent, colspan: 2]Cryoglobulin [/TD] [/TR] [TR] [TD=width: 216, bgcolor: transparent, colspan: 2]Platelets [/TD] [/TR] [TR] [TD=width: 108, bgcolor: transparent]Albumin 4.5% 100ml or 400ml [/TD] [TD=width: 108, bgcolor: transparent]Albumin 20% 100ml [/TD] [/TR] [TR] [TD=width: 216, bgcolor: transparent, colspan: 2]Immunoglobulin (g) [/TD] [/TR] [TR] [TD=width: 216, bgcolor: transparent, colspan: 2]Other : please specify [/TD] [/TR] [TR] [TD=width: 379, bgcolor: transparent](For Lab use only) Dispatched to (ward) : By: Date/Time [/TD] [TD=width: 216, bgcolor: transparent, colspan: 2](For Lab use only) Ward notified : (record who) Date/Time [/TD] [/TR] [/TABLE]
