Routine requisition:

Use this form for routine laboratory test requests on blood samples. If the test you desire is not listed write the full name of the test in the lower right corner of the form. Please include your contact information and the ICD-9 diagnostic codes for the patient at the top of the form together with the patient's name and birth-date.

Urine & Body fluid requisition:

Use this form for routine laboratory test requests on urine or body fluid samples. If the test you desire is not listed write the full name of the test in the lower right corner of the form. Please include your contact information and the ICD-9 diagnostic codes for the patient at the top of the form together with the patient's name and birth-date.

Microbiology requisition:

Use this form to request bacterial, fungal, mycobacterial, viral and parasitology testing. Include the specimen source as well as the test(s) required. Pertinent patient history and/or suspected pathogen information should be included in the space provided. Please include your contact information and the ICD-9 diagnostic codes for the patient at the top of the form together with the patient's name and birth-date.

Molecular diagnostics:

Use this form for ordering molecular genetic testing for both inherited and neoplastic disorders. Note the Genetic counseling attestation requirements.

Cytogenetics:

Use this form when ordering classical cytogenetic (e.g. chromosomal analysis) for prenatal or postnatal samples.

Lymphocyte Stimulation Study Form:

Note: Must be printed on pink paper stock to ensure proper handling