<!-- BEGIN [% component.name %] -->

  <div class="request_form">
    <div align="center">
    	<img src='/images/outreach_header.png' alt="" />
    </div>

    <p class="address">
      [% c.cfg('settings').lab_name_abbreviation %],
      [% c.cfg('settings').service_address %]
    	Telephone: [% c.cfg('settings').service_telno %] ~ FAX: 0113 206 7883
    </p>
    
    <h2>Outreach monitoring service for haematological disorders</h2>
    
    <p>Enclosed is a pack for monitoring your disorder. Please read the instructions
    below before you continue. It is important that you <b><u>do not seal the
    pack</u></b> until you have been to the general practice. </p>
    
    <ul class="cover">
        <li>
            Please make an appointment to see the nurse or phlebotomist at your
            general practice. The appointment should be on a Monday, Tuesday,
            Wednesday. <b>No appointments should be made on a Friday</b> - the
            samples will be too old by the time they get to us and so it is better
            to wait for an appointment at a later date.  
        </li>
        
        <li>
            Please complete the questionnaire before you go to the general
            practice. If you have any problems completing the questionnaire,
            please contact us on the telephone number or email address below. 
        </li>
        
        <li>
            When you go to the general practice, please <b>take this letter along
            with all the other paperwork and the blue pack</b>. The nurse or
            phlebotomist will take the blood samples. Please give them with your
            completed questionnaire to put in the pack before sealing it.  
        </li>
    </ul>
    
    <p>Information for the nurse/phlebotomist:</p>
    
    <ul class="cover">
        <li>
            If the blood tubes in the pack are different to the tubes routinely
            used at your practice, please discard them and use your own tubes –
            1 x EDTA (e.g. full blood count) and 2 x serum (e.g. U&amp;E). 
        </li>
        
        <li>
            Please ensure that the pack contains: blood samples, HMDS request
            form, biochemistry and immunology request forms, completed symptom
            questionnaire and EQ-5D ("assessing your current health state").  
        </li>
        
        <li>
            Once the pack is sealed and the address label is put in place, it is
            safe to send in the post like a normal letter – there is no need to
            put it in an envelope and the <b>postage has already been paid</b> as
            stated on the address sticker. <b>The practice nurse or phlebotomist
            should send the pack with the rest of the practice mail</b>. Please
            contact us if there might be any delay in posting as the pack needs
            to be returned as soon as possible after the samples have been taken. 
        </li>
    </ul>
    
    <p>If you have any problems please contact HMDS on 0113 2067851 and ask to
    speak to somebody about Outreach monitoring or email
    victoria.martin@leedsth.nhs.uk</p>
  </div>
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