Cytopathology Requisition

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:

Gynecological (PAP) Cytopathology Requisition (CLS Form# REQ9043CY-GYN):

  • Complete the Specimen Site section
    • Cervix, vagina, other
    • Pap taken at Colposcopy
    • First Colposcopy visit
  • Complete the Clinical Information section
    • LNMP and Cycle
    • Previous Pap result
    • Other relevant clinical history

Non-Gynecological Cytopathology Requisition (CLS Form# REQ9041CY-NON);

  • Complete the Specimen Collection Method section
    • BAL, Brush, Fluid, FNA, Scrape, Wash, Other
  • Complete the Specimen Site section
    • Body site, source of specimen, type of specimen
  • Complete the Clinical Information section
    • Relevant clinical history

Colposcopy Pathology Requisition (CLS Form# REQ9042COL):

  • Complete the First Colposcopy Visit section
  • Complete the Gynecology History section
  • Complete the Prior Treatment and Colposcopic Finding sections if applicable
  • Complete the specimen details section
    • biopsy, punch, cone, location___ o'clock, cervix, vagina, vulva, other, curettings, endocervix, endometrium