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IMMUNOHISTOCHEMICAL REQUEST FORM (CPL 4001A/ 3174916326) PATIENT NAME: DATE OF BIRTH: COLLECTION DATE: ACCESSION #: CLIENT NAME: BLOCK #: REQUESTED BY: LAB USE ONLY Date In: Date Out: Total Slides:
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How to fill out an immunohistochemical request form CPL:

01
Start by carefully reading and understanding the instructions provided on the form. Familiarize yourself with the required information and any specific guidelines or requirements.
02
Begin by filling out the basic details section of the form. This typically includes identifying information such as your name, contact information, and the date.
03
Next, provide the necessary patient information. This may include the patient's name, date of birth, gender, and any relevant medical history or clinical information.
04
Specify the type of sample or specimen being submitted for immunohistochemical testing. This could be tissue, cells, or any other appropriate sample.
05
Indicate the specific tests or markers that you would like to be performed. List them clearly on the form, ensuring accuracy and completeness. If you are unsure which markers to request, consult with a pathologist or a healthcare professional familiar with immunohistochemistry.
06
If applicable, provide any additional instructions or information regarding the required testing. This may include specifying the preferred staining method, any special handling requirements, or requesting rush or priority processing.
07
Review the completed form for any errors or missing information. Double-check that all sections have been filled out correctly and any necessary supporting documents or requisitions have been included.

Who needs an immunohistochemical request form CPL:

01
Patients or individuals requiring immunohistochemical testing for diagnostic or research purposes may need to fill out an immunohistochemical request form CPL.
02
Healthcare professionals, such as doctors, pathologists, or researchers, who are requesting immunohistochemical testing for their patients or research projects, would also need to complete this form.
03
Laboratories or facilities performing immunohistochemical testing may require a completed request form to ensure proper handling and processing of the samples, as well as to accurately perform the requested tests.
Please note that specific requirements for filling out the form and who needs it may vary depending on the institution, laboratory, or specific testing guidelines. It is always recommended to follow the instructions provided by the relevant healthcare professionals, pathologists, or testing facility.
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The immunohistochemical request form cpl is a document used to request immunohistochemical testing for tissue samples.
Medical professionals and researchers who need immunohistochemical testing done on tissue samples are required to file the form.
The form should be filled out with the patient's information, the details of the tissue sample, and the specific testing requested.
The purpose of the form is to request specific immunohistochemical testing on tissue samples for diagnostic or research purposes.
The form must include patient information, details of the tissue sample, requested testing, and contact information of the requester.
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