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Guidelines for Medical Professionals

Guidelines for healthcare professionals are subject to change. To ensure quality samples please use the most current forms which are available below.

Chemistry

CH3012 Diet for 72 Hour Fecal Fat Collection

CH3072 How to Collect a 24 Hour Split Urine Specimen

CH3003 How to Collect a 24 Hour Urine Specimen

CH3025 How to Collect a 24 Hour Urine Specimen for Creatinine Clearance

CH3022 How to Collect a 72 Hour Stool Specimen for Fecal Fat

CH3007 How to Collect a Fecal Occult Blood Guiacic Stool Collection

CH3000 How to Collect a Home Hemodialysis - Self Collection

CH3034 How to Collect a Saliva Specimen for Cortisol Testing

CH3004 How to Collect a Timed Urine Specimen

CH3008 How to Collect a Urine Specimen for 5-HIAA

CH3011 Maternal Serum Prenatal Screen

CH3002 Preparation for a Glucose or Lactose Tolerance Test

CH3067 Preparation for a Helicobacterpylori Breath Test - UBT

Drug Screens

PX4162  Drug Screen Comprehensive Drug Analysis Medical History Form

Microbiology

MI6002  Malaria History Form

MI6004  Instructions for the Collection of Superficial Mycology Specimens

MI6005  Collection of Specimens for Anaerobes - Guideline for Physicians

MI6006  Critical Eye Specimen Instructions - Guideline for Physicians

MI6106  Gastric or Duodenal Biopsy Collection for Helicobacter Collection  

MI6115 Malarial Smear Preparation

Physician Information Forms

CSD2703 Delivery of Hard Copy Reports During a Health Care Provider Absence

CSD2708 Healthcare Provider Information Form

Special Coagulation

SC4900 Hemostasis Studies History Form

SC4901 Lupus Type Inhibitor History Form

SC4902 Thrombophilia Screen/Related Procedures History Form

SC4904 Factor Xa History Form

SC4915 Heparin Induced Thrombocytopenia Antibody (HITABS) History Form

Transfusion Medicine

REQ9002TM ACH Blood Product Order Fax Requisition

REQ9006TM Blood Product Order Fax Requisition

TM1555 Sites External to CLS Supply Request List Fax Form

TM1623 Instructions for Patient Pick Up of Rh Immune Globulin

TM2027 Identification Band for Pretransfusion Testing

TM2034 Adverse Reactions to Blood Products Notification

TM2038 Immune Globulin Initiation Form

TM2145 Recycling Product (External Sites Packaging Slips)

TM2153 Cord Blood DAT Request Fax

TM2191 Physician Request for Transfusion Summary 

TSO1327 Rh Prophylaxis for Cellular Therapy Patients