Mobile Site ›
Print Page Email Page

Test-Specific Forms

The specimen submission requirements (refer to our test catalog) identify the forms required for each test.

Test Requisition Forms

For clients that do not order tests electronically, we typically supply printed test requisition forms that include the client's account number. Use of these forms ensures timely and accurate results. Contact customer service if you need additional test requisition forms.

Do not submit specimens without first obtaining an account number. Ordering your first test provides the step-by-step process.

Molecular Genetics Request Form

Commonly Used Forms

The list below provides many of the commonly used forms.

  1. Select and print the needed form
  2. Add the appropriate information to the form
  3. Make a copy of the completed form if required by your local procedures
  4. Include the form with your test requisition

If a form is not available from this list, contact customer service.

 

Form Name Supply# Document#
Allergens, Listing of Available T470 MC0901-02
Biochemical Disorders Patient Information, Molecular Genetics T527 MC1235-100
Bone Histomorphometry Information T352 MC1235-59
Bruton’s Tyrosine Kinase (BTK) Genotype Patient Information T620 MC1235-132
Busulfan Information T559 MC1235-112
Calcium Sensing Receptor (CASR) Mutation Screening Patient Information T551 MC1235-110
Chimerism Analysis Information Sheet T594 MC1235-124
Coagulation Patient Information Sheet T675 MC1235-169
Congenital Inherited Diseases Patient Information, Molecular Genetics T521 MC1235-97
CYP21A2 Gene Testing Patient Information Sheet T663 MC1235-164
Cytogenetics – Array CGH Testing Patient Information Sheet T665 MC1235-166
Cytogenetics Hematologic FISH Panel Patient Information T603 MC1235-134
Cytomegalovirus QN Immune Competence Assay Pt Info Sheet T592 MC1235-121
Electron Microscopy Patient Information Sheet T660 MC4091-35
Familial/Autosomal Dominant Hypercholesterolemia T637 MC1235-141
FBN1/TGFBR2/TGFBR1 Gene Testing Patient Information Sheet T636 MC1235-159
First Trimester/Sequential Maternal Screening Patient Information Sheet T593 MC1235-122
Hemophilia B Patient Information T518 MC1235-99
Hereditary Hemorrhagic Telangiectasia (HHT) Gene Testing T650 MC1235-155
Informed Consent for DNA Testing T576 MC1235-117
Inherited Cancer Syndromes Patient Information, Molecular Genetics T519 MC1235-98
Lead/Heavy Metals Reporting T491 MC1235-69
Leukemia/Lymphoma Immunophenotypng Hold T503 MC1235-89
Muscle Histochemistry Patient Information T361 MC1235-68
Orthostatic Protein Measurement 24-Hour Urine Patient Collection Instructions T546 MC4091-06
Renal Biopsy Patient Information T231(kit) MC1235-45
Respiratory Chain Complex Patient Information, Biochemical Genetics T542 MC1235-108
SDHB, SDHC, SDHD Gene Testing Patient Information Sheet T659 MC1235-160
Second Trimester Maternal Screening Alpha-Fetoprotein (AFP)/Quad Screen Patient Information Sheet T595 MC1235-123
TACI Genotyping Patient Information Sheet T604 MC1235-131
Thalassemia/Hemoglobinopathy Information T358 MC1235-36
trEC Assay Patient Information Sheet T589 MC1235-119
UGT1A1 Gene Testing for Hyperbilirubinemia Patient Information Sheet T664 MC1235-165
VHL Gene Testing Patient Information Sheet T641 MC1235-144