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Immunohistochemistry Requisition ACCOUNT INFORMATION Immunohistochemistry Laboratory Lab: 2146480484 FAX: 2146480495 Customer Service: 2146457057 Toll Free: 8778878136 www.veripathlabs.com 6201 Harry
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How to fill out immunohistochemistry requisition form
How to fill out immunohistochemistry requisition form:
01
Start by filling in your personal information, such as your name, contact details, and the date.
02
Next, provide information about the patient whose tissues or samples are being submitted for immunohistochemistry analysis. This includes the patient's name, identification number, date of birth, and any relevant medical history.
03
Indicate the type of specimen being submitted, such as tissue biopsy, cytology specimen, or blood sample.
04
Specify the source of the specimen, whether it is from surgery, autopsy, or another source.
05
Include information about the specimen fixation, including the type of fixative used and the duration of fixation.
06
Provide a detailed description of the clinical question or reason for requesting the immunohistochemistry analysis. This could include suspected diagnoses, specific markers to be stained, or any other relevant information.
07
Indicate any special stains or additional testing requested, if applicable.
08
Include the healthcare provider's information, such as their name, medical license number, and contact details.
09
Sign and date the requisition form to confirm that all the provided information is accurate and complete.
Who needs immunohistochemistry requisition form?
01
Healthcare providers or medical professionals who require immunohistochemistry analysis for their patients.
02
Researchers or scientists who are conducting studies or experiments that involve immunohistochemistry analysis.
03
Pathologists or laboratory technicians who receive and process specimens for immunohistochemistry analysis.
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What is immunohistochemistry requisition form?
Immunohistochemistry requisition form is a form used to request specific tests to be performed on tissue samples to identify the presence, absence, or abnormality of certain proteins.
Who is required to file immunohistochemistry requisition form?
Medical professionals such as pathologists, oncologists, and researchers are required to file immunohistochemistry requisition forms.
How to fill out immunohistochemistry requisition form?
The form typically requires information such as patient details, sample information, requested tests, and relevant clinical history. It is important to fill out the form accurately and completely.
What is the purpose of immunohistochemistry requisition form?
The purpose of the form is to ensure that the correct tests are performed on tissue samples, allowing for accurate diagnosis and treatment decisions.
What information must be reported on immunohistochemistry requisition form?
Patient details, sample information, requested tests, clinical history, and any other relevant information must be reported on the form.
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