Healthcare Providers

Requisition Forms

Forms

Requisition Forms

Instructions
There are two types of requisition forms: Gyn Pathology and Surgical Pathology.

Use the Gyn requisition for Gyn related specimens e.g. cervical biopsies, Pap tests, related ancillary testing, and breast FNAs. The form has been customized to make test ordering easier for Gyn related specimens. If other biopsies or specimens are obtained during the exam, include them in the Histology or Nongyn Cytology/FNA section.

Use the Surgical Pathology Requisition for most biopsy specimens and nongyn cytology specimens.

The requisition is the only way we know what your instructions, patient’s identifiers and billing information are. We can’t begin processing specimens until we have the correct information. Incomplete information causes delays for you and your patient. A correctly completed requisition will result in fewer calls to your office and less work for your office staff.

Click on the appropriate requisition button below to print the form.
To print multiple copies, enter the number of copies in the print dialogue box.

Gyn Pathology Requisition Surgical Pathology Requisition