Get the free IMMUNOHISTOCHEMICAL REQUEST FORM - iuhealth

IMMUNOHISTOCHEMICAL REQUEST FORM Please check one: 350 W. 11th Street, Rm 4001A Indianapolis, IN 462024108 3174916326 Inpatient Outpatient Ambulatory Sure Center PATIENT Names: DATE OF BIRTH: COLLECTION

How to fill out immunohistochemical request form

How to Fill Out Immunohistochemical Request Form:

1. Begin by writing your name, contact information, and the date at the top of the form. This will help the laboratory staff to reach you and keep track of your request.
2. Provide the patient's relevant information, such as their name, date of birth, and any unique identifiers like a medical record number. This will ensure that the test is correctly associated with the patient.
3. Specify the location where the tissue sample was obtained from the patient. This can include details like the organ or the specific site within the organ.
4. Indicate the reason for requesting the immunohistochemical test. This may include providing a brief clinical history or explaining the suspected diagnosis or disease.
5. If there are any specific stains or markers that need to be used in the analysis, clearly state them in this section. This helps ensure that the lab performs the correct tests and interpretations.
6. Include any additional information or special instructions that may be relevant to the request. This could include details about the requested turnaround time, specific methodologies, or other special considerations.
7. Finally, sign and date the form to confirm your authorization and submission of the request.

Who Needs an Immunohistochemical Request Form:

1. Physicians and healthcare providers who suspect a particular diagnosis or disease that can be confirmed or supported by immunohistochemical testing may need to fill out this form. It allows them to request specialized laboratory tests to aid in the diagnosis.
2. Researchers in the field of pathology, oncology, or other related disciplines may also require this form to submit tissue samples for immunohistochemical analysis. This is important for studying diseases, understanding biomarkers, or developing new treatment strategies.
3. Patients undergoing medical procedures or surgeries that involve tissue biopsies may have their healthcare providers fill out this form to ensure that the appropriate immunohistochemical tests are conducted on their samples. This can help guide treatment decisions or monitor the effectiveness of therapies.

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What is immunohistochemical request form?

The immunohistochemical request form is a document used to request immunohistochemistry testing on tissue samples.

Who is required to file immunohistochemical request form?

Medical professionals such as pathologists, oncologists, and surgeons may be required to file the immunohistochemical request form.

How to fill out immunohistochemical request form?

The form should be completed with patient information, tissue sample details, requested tests, and relevant clinical information.

What is the purpose of immunohistochemical request form?

The purpose of the form is to provide necessary information for the laboratory to perform immunohistochemical testing on tissue samples.

What information must be reported on immunohistochemical request form?

Patient demographics, specimen source, clinical history, and specific tests requested are some of the information that must be reported on the form.