Universal Umbilical Cord Collection Log Patient Identification Date Collector Purpose Date Processor Purpose Name and ID Number (The individual adding specimen to (The individual removing specimen from temporary storage) temporary storage) sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy sign sign Collected Specimen Select for Testing and Transferred to print print Temporary Storage Destroy Rev.0_15.01.28
Universal Umbilical Cord Collection Log Patient Identification Name and ID Number Date Collector (The individual adding specimen to temporary storage) Purpose Date Processor (The individual removing specimen from temporary storage) Purpose sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print sign Collected Specimen and Transferred to Temporary Storage sign Select for Testing Destroy print print Rev.0_15.01.28
Univ_Collection_Log_Web.docx