Molecular Hematology Requisition

Demographic and Test Order Information

Specimens must be accompanied by requisitions with complete Demographic and Test Order Information.

Additional Information

Molecular Hematology requisitions should be used to avoid delays in specimen transport. To assist the laboratory in proper sample processing and interpretation of results, include clinical diagnosis and transplant/treatment history for specimens requiring molecular analysis.
For hemostatis and thrombosis gene studies, include a clinical diagnosis and a personal and/or family history.
Check off the test requested in the appropriate box(es). Refer to requisition for ordering guidelines for molecular studies.

Requisitions may be obtained from Molecular Hematology by calling 770-3699.