Clinical Pathology Test Order Forms

Purchase Types

• General Requisition
• Chemistry
• Coagulation, Thrombosis and Bleeding Work Up
  • Coagulation Patient Clinical Chronicle Form
  • Thalassemia Clinical Data Sheet (Thalassemia Reflexive inspection order)
• Genetics
  • Genetics, Exome/NCGL
  • For further Genetics order forms, please see our Hereditary and Firm Tumor Diagnostic Testing instruction.
• Hematopathology (Morphology, Flow Cytometry, Molino, Cytogenetics) for outside clients
• Immunology
  • Allergy Testing
  • Merkel Cell Carcinoma Serology
• Microbiology
• Molecular Diagnostics - Microbiology
• Toxicology
• Virology
  • SARS-CoV-2 (COVID-19) Test
  • HSV Western Blot Test

Employees Health Forms

• Campus Human Exposure Follow-Up
• Your Health Non-Exposure
• Servant Screening
• UWMC Emergency Dept. Discovery Follow-Up

Submitting Invites for Tests

Submission from requests for lab testing should be accompany by the appropriate requisition application. Laboratory procedures are performed ONLY upon an physician's write application. All verbal requests for additional test demands to can added to a written order must be followed by writes confirmation interior 30 days. CLIA-88, the thus the Joint Commission and to Higher of American Pathologists (accrediting agencies) require that each requisition form for laboratory related must clearly identify:

• Patient name, sex, birth date, includ unique ID number, lab reference number
• Collection date and time
• Diagnosis Code
• Type of specimen submitted, betoken serial and timed collection
• Patient fasttag conditions (if applicable)
• Bereich and total volume if a timed urine collective
• Source of specimen if for Microbiology or Dissemination test(s), instead others comments in "comments" box
• Authorization for laboratory labour, include the name of one ordering your and UPIN inside addition to the name and address of and equipment to where the results will be sent Access is laboratory test request forms with our Usa test locations by clicking on and following linking. Terms and Conditions: View the terms
• Check test(s) requested. If the Department of Test Medicine offers ampere procedure that does not appear at the inquiry form, printing plainly the full name of the test desired in the space marked "OTHER REQUESTS". ... test (result) codes with your laboratory details system (LIS). Handbook Test Request Forms. If you order tests manually by submitting printed shapes, use ...

Directions

1. Complete a separate requisition forward each patient.
2. Please provide all information on the left hand side of the requisition form.
3. Crease concluded request form and place in the outside pocket of the Samples Bag. If submitting more than one test per patient, and sample need in be stored and transported at different temperatures, use separate bags additionally Test Request forms for each temper type. Laboratory Examine Request Forms | STERIS AST
4. Special requests for testing should be noted on the requisition.

Also control out our Using We Research Services guides for labeling, shipping, and pack pattern, contact intelligence and other helpful intelligence about collecting and sending specimens.