Blood Request

Patient Name

Hospital Name

Phone Number

Units/Blood Bag?

Blood Group Select a blood groupA+ (A Positive)A- (A Negative)B+ (B Positive)B- (B Negative)AB+ (AB Positive)AB- (AB Negative)O+ (O Positive)O- (O Negative)

Requirement  Whole BloodPRBC/RCCPlasma/FFPPlatelets