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

CH3011  Maternal Serum Prenatal Screen

Drug Screens

DS3601  Medical Drug Screen History Form for Community

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

MI6015  Herpes DFA Slide Specimen Collection - Guidelines for Physicians

MI6106  Gastric or Duodenal Biopsy Collection for Helicobacter Collection  

MI6115 Malarial Smear Preparation

Physician Information Forms

CSD2703 Report Distribution During a Physician's Absence Form

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

TM1623 Instructions for Patient Pick Up of Rh Immune Globulin

TM1641 Rh Prophylaxis for Cellular Therapy Patients

TM2038 Intravenous Immune Globulin (IVIG) Hisory Form

TM2027 Identification Band for Pretransfusion Testing

TM2034 Adverse Reactions to Blood Products Notification

TM2153 Cord Blood DAT Request Fax

TM2191 Physician Request for Transfusion Summary 

TM2157 Intravenous Immune Globulin (IVIG) Administration Information

TM1555 Sites External to CLS Supply Request List Fax Form

TM2145 Recycling Product (External Sites Packaging Slips)

REQ9002TM ACH Blood Product Order Fax Requisition

REQ9006TM Blood Product Order Fax Requisition