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Histopathology Requisition
MOLECULAR ONCOLOGY1351 Barclay Blvd., Buffalo Grove, IL 60089
Tel: 855.467.2849 Fax: 224.588.9941
www.gopathlabs.comPATIENT INFORMATION (Please print)ORDERING PHYSICIAN
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How to fill out hematopathology requisition
How to fill out hematopathology requisition
01
Fill out patient's demographic information including name, date of birth, and medical record number.
02
Specify the test(s) requested such as complete blood count (CBC), blood smear review, flow cytometry, etc.
03
Provide clinical history and reason for the test request.
04
Include information on any previous relevant lab results or pertinent medical history.
05
Sign and date the requisition form to authorize the test request.
Who needs hematopathology requisition?
01
Patients who are suspected to have hematologic disorders or abnormalities.
02
Physicians or healthcare providers who are managing patients with blood-related conditions.
03
Laboratory technicians or pathologists who will be performing the hematopathology tests.
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What is hematopathology requisition?
Hematopathology requisition is a form or document used to request the evaluation of blood and bone marrow samples for the diagnosis of blood-related disorders, including leukemia and lymphoma.
Who is required to file hematopathology requisition?
Healthcare providers, such as physicians and pathologists, are required to file hematopathology requisition to obtain laboratory analysis of hematologic samples.
How to fill out hematopathology requisition?
To fill out a hematopathology requisition, provide patient demographics, clinical history, the type of specimen submitted, and any specific tests requested by the physician.
What is the purpose of hematopathology requisition?
The purpose of a hematopathology requisition is to formally request laboratory analysis of hematologic specimens to aid in diagnosing and managing blood diseases.
What information must be reported on hematopathology requisition?
Required information includes patient name, date of birth, medical record number, relevant clinical history, type of specimen, and the requesting physician's information.
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