ContractMedical Service Agreement • October 14th, 2024
Mr. ❑ Mrs. ❑ (IN UPPER CASE, please)Name:…………………………………………………………… DIAGNOSTIQUE / Service de Médecine GénétiqueCentre d’accueil des prélèvements (CAP)Bâtiment des Laboratoires (BATLab), local 8D-0-850.1 4 rue Gabrielle-Perret-Gentil, 1211 Genève 14 Maiden Name:…………………………………………………..First name :……………………………………………………..Date of birth : ........... / ............ / ……………Legal representative (for minors) : ❑father ❑mother Genomic and Molecular Diagnostics LaboratoryAccredited since 2003, formerly STS 0382 Name/first name :……………………………………………Street/N°:……………………………………………………… DIAGMOL http://www.hug-ge.ch/feuilles-de-demande Town, ZIPCODE :………………………………………………….Hospitalisation Unit: …………… Physician :…………………… Head of Genetic Medicine Division : Prof. Marc ABRAMOWICZ Head of Laboratory, medical genetics FAMHDr. sc. J.-L. BLOUIN, jean-louis.blouin@hcuge.chBiologists laboratory managers, medical genetics FAMH Dr. Th. NOUSPIKEL, thierry.nouspikel@hcuge.chDr. sc. M. GUIPPONI, michel.guipponi@hcuge.chLab direct
ContractMedical Service Agreement • November 30th, 2018
Mr. ❑ Ms. ❑ (please print clearly)Name:……………………………………………………................Maiden name :…………………………………………………….... DIAGNOSTIQUE / Service de Pathologie Clinique First name :……………………………………………………......... Centre d’accueil des prélèvements (CAP) Date of birth : ............ / ............ / …………… Bâtiment des Laboratoires (BATLab), local 8D-0-850.1 Legal representative for minor patient : ❑ father ❑ mother 4 rue Gabrielle-Perret-Gentil, 1211 Genève 14 Name/first name : ………………………………………………….. Laboratoire d’oncologie moléculaire et pharmacogénomique Street/N°:…………………………………………………………….... ONCOMOL http://www.hug-ge.ch/feuilles-de-demande City, Zip code :…………………………………………………….....Hospital Unit : …………… Doctor :…………………….. Médecin Chef : Prof. Laura Rubbia-BrandtResponsable du laboratoire : Dre A.-L. Rougemont (022 37) 28 568Responsable technique FAMH : Mme I. Gauchat-Bouchardy (022 37) 21 827Labo direct ou résultats : Tél./Fax : (022 37) 21 830 / 21 843 N° EdS : ……………………………………………………………….Adress for fa