Sample draw	Date dd/mm/yy	Time (24 hour clock)	Total volume Withdrawn (mL)	Volume line clearance (mL)	Line clearance: (D)iscarded (R)eturned	Reason for blood sampling (R)outine (M)edical request (L)ab request - rebleed (O)ther	Access type (C)VAD (I)V - Peripheral (S)tab - Peripheral (A)rterial (P)rick - finger/heel	Collection method (V)acutainer (S)yringe (C)apillary
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Was the patient DISCHARGED during the audit period: Yes No If yes, discharge date: