Completing Request Forms PDF

Mutli-disciplinary requests (Chemistry, Haematology and Immunology) from within the Trust and from General Practices.

The tables below indicate the essential data required on samples and request forms and outlines the desirable information which ideally should also be included.

SPECIALIST INFORMATION IS REQUIRED FOR HISTOLOGY, CYTOLOGY, ANDROLOGY AND BLOOD BANK REQUEST SEE INDIVIDUAL DEPARTMENTAL SECTIONS

 

Essential

 

Desirable

 

Request Form

 

1. Full name or coded identifier

 

2.PID or NHS number or date of birth

 

3.Location or destination for report

 

4.Consultant or General Practitioner

 

1. Other information listed under essential if not used as an essential option.

2.Clinical information

 

3.Date and time sample collected (becomes essential when time factors affect test results)

 

4.Patients address

 

5.Patients sex

 

6.Practitioners bleep number

 

7.Name of requesting practitioner

 

Specimen

1. Full name or coded identifier whichever is given on form

2.PID, NHS number or date of birth whichever is given on form

 

1. Other information listed under essential if not used as an essential option

2.Date and time taken

 

3.Destination for report

 

Requests from Other Hospitals for Chemistry, Haematology and Immunology Specimens.

 

Essential

 

Desirable

 

Request Form

1 identifier from each of 2 of the 3 sets listed below.

 

 

1. Name or coded identifier

2.PID, NHS number or date of birth

 

3.Requesting laboratory number

 

4.Location or destination for report

 

1. Other information listed under essential if not used as an essential option

2.Clinical information

 

3.Date and time sample collected (becomes essential when time factors affect test result)

 

4.Patients address

 

5.Patients sex

 

6.Name of requesting practitioner/ department

 

Specimen

 

1 identifier from each of 2 of the 3 sets listed below

and also stated on the request form.

 

 

1. Full Name or Coded identifier

2. PID or NHS number or date of birth

 

3.Requesting laboratory number

 

1. Other information listed under essential if not used as an essential option

2.Date and time taken

 

3. Destination for report

 

Last Updated on Friday, 14 May 2010 09:11
 

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