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Please print neatly in pen or type. Please indicate funding type and Cancer Center membership. Direct questions to: Stephen Serio, Research Coordinator, pserio1@uthsc.eduPrincipal Investigator Name:Faculty
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How to fill out specimen request - histology

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How to fill out specimen request form

01
Begin with the patient's identification details: full name, date of birth, and medical record number.
02
Specify the type of specimen needed (e.g., blood, urine, swab).
03
Indicate the test or tests required for analysis.
04
Fill in the clinical information or symptoms related to the patient's condition.
05
Include the date and time the specimen was collected.
06
Provide the name and contact information of the healthcare provider requesting the test.
07
Check for any special instructions necessary for specimen handling or transport.
08
Review the form for completeness and clarity before submission.

Who needs specimen request form?

01
Healthcare professionals including doctors, nurses, and laboratory technicians who require testing for diagnosis or treatment.
02
Clinics and hospitals that perform routine medical tests on patients.
03
Research institutions conducting studies that involve biological specimens.

What is Specimen Request - Histology Services Form?

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A specimen request form is a document used to formally request biological specimens for laboratory analysis or testing.
Typically, healthcare providers, laboratories, or researchers who need to obtain or analyze biological specimens are required to file a specimen request form.
To fill out a specimen request form, include patient information, type of specimen, relevant clinical details, and signature of the requesting physician or authorized personnel.
The purpose of the specimen request form is to provide necessary information for the collection, handling, and analysis of biological specimens while ensuring accurate processing and reporting.
Information that must be reported includes patient identification, specimen type, test requested, clinical history, and any special handling instructions.
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