Get the free SURGICAL PATHOLOGY REQUISITION FORM

ASHORE PATHOLOGY J. Augusto Ross, MD, CAP 18308 MURDOCK CIRCLE, SUITE 105 PORT CHARLOTTE, FL 33948 PHONE: (941) 3139009 FAX: (941) 6239532 P A T I E N T COMMENTS Medical Director SURGICAL ID PHYSICIANS

How to fill out surgical pathology requisition form

How to fill out a surgical pathology requisition form?

1. Start by gathering all the necessary information: Before filling out the form, make sure you have the patient's personal details such as their name, date of birth, contact information, and medical record number, if applicable. It's also important to have the ordering physician's information, including their name, address, and contact details.
2. Provide clinical information: The surgical pathology requisition form requires specific clinical details about the patient's condition. Fill in information about the reason for the request, relevant symptoms, previous diagnoses, and any relevant medical history. This information will help the pathologist accurately analyze the specimen.
3. Specify the specimen details: Clearly indicate the type of specimen being submitted, such as a tissue sample, biopsy, or other body fluids. Include the anatomical site from where the specimen was obtained, as well as any relevant details about the specimen's appearance, size, or quantity.
4. Choose the desired tests: Select the appropriate tests or analyses requested for the specimen. This may involve checking boxes or writing down specific test names. If you are unsure about which tests to request, consult with the ordering physician or the pathologist to ensure you select the appropriate options.
5. Indicate the urgency and date of request: If the specimen requires immediate attention, make sure to denote its urgency in the provided section. It's also crucial to include the date of the request, ensuring accurate tracking and prioritization.
6. Sign and provide required signatures: The form may require multiple signatures depending on the institution's policies. The ordering physician must sign to authorize the request, and if applicable, the patient's consent signature may be necessary as well. Additionally, the individual filling out the form should also sign and date it.

Who needs a surgical pathology requisition form?

1. Surgeons: Surgeons are among the primary users of surgical pathology requisition forms. They use these forms to request the analysis of tissue samples or specimens collected during surgery, aiding in the diagnosis and treatment of patients.
2. Physicians and specialists: Other physicians, such as dermatologists or gastroenterologists, may also require surgical pathology requisition forms. They utilize these forms when requesting pathological analysis of samples collected during procedures or examinations to assist in diagnosing and managing patients' conditions.
3. Pathologists: Pathologists themselves may need surgical pathology requisition forms when initiating further testing or analysis on a specimen received from another facility. In these cases, the requisition form serves as a record of the request and provides necessary information for accurate interpretation.
4. Hospital or laboratory administrators: Administrators responsible for overseeing the workflow and coordination of patient care in hospitals or laboratories may also interact with surgical pathology requisition forms. They ensure that the forms are properly filled out, signed, and recorded for optimal patient care and billing purposes.

Note: The usage and requirement of surgical pathology requisition forms may vary depending on institutional practices, local regulations, and specific medical specialties. It's always important to consult with the respective healthcare facility and professionals involved to ensure adherence to their guidelines.

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