Cytopathology Requisition (#CY0001)

Demographic and Test Order Information

Correct and complete Demographic and Test Order Information is required on all requisitions.

Additional Information

A completed requisition form must accompany each specimen with the following clinical information:

• Cervico-vaginal (PAP) smears:
• Complete all boxes in the history area
• Other history as required
• Previous history when relevant
• Source of specimen
• Type of specimen
• Other Cytopathology appropriate history
• Previous history when relevant
• Source of specimen(s)
• Type of specimen(s)