Regulatory Referenced Standard (iii) Laboratory / Test Lab Information Lab Facility Name Aloha Laboratories / /
Facility
Incorporate laboratory / Facility City Shawville Lab Facility State Pennsylvania Lab Facility Zip Code / Drue Street Lab Facility / /
IndustryTerm
healthcare / communications configuration information / /
Organization
Department of Health and Human Services / Test Result Unit of Measure mg/dl Test Specimen Source Not Applicable Condition/Disposition / Test Result Unit of Measure mg/dl Test Specimen Source Not Applicable Condition/Disposition of Specimen Not Applicable Test Report Date / /
Person
Robert Patient / Barbara Patient / Jonas Patient / Susan Patient / Johnathan Patient / /
Microsoft Word[removed]g_IncorpLabTest_v0.4.doc