Completing a request form

If you work in a hospital trust, GP surgery or at a community site

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Microbiology test request form

Clinical Blood Sciences test request form

Diagnostic Cytology test request form

Histopathology test request form

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PATIENT DETAILS – each request form MUST contain the following patient identification criteria:

• The patient’s NHS or Medical Record Number
• The patient’s family and given names
• The patient’s date of birth

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CLINICAL REPORTING – necessary to interpret the results and display the appropriate reference range of the tests

• Date and time the specimen was collected
• The gender of the patient

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PRE-PRINTED LABELS – these may be used to provide the patient details provided they are attached as indicated on the form itself.

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TESTS – tick the appropriate tests on the form or print clearly any additional ones that are not included.

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EXCEPTIONS

Requests from patients whose identity is incomplete will only be accepted, if they fall into the following categories:

• Unknown patients attending A&E. These will be identified using agreed, local rules.
• Forms requesting either Histology or Diagnostic Cytology investigations should include the full name of the consultant together with their GMC number. This will overcome any confusion regarding the identity of the requestor.
• New born babies without a Given name can be identified as Baby Smith for instance, but must have a MRN number and date of birth.
• Twins without Given names can be identified using Twin 1, Smith and Twin 2, Smith. Again the MRN number and date of birth must be provided.
• Specimens from patients attending the GU Medicine clinic need not display all of the Core Identifiers, but only show a unique patient number and the patient’s Date of Birth.
• HMP patient requests, only display the patient’s DOB and surname
• Private patients not having an NHS or MRN number. The request should clearly show they are a private patient. The first line of the patient’s address should be included on the request form and written on all specimen containers.

Antenatal Screening requests

For requests made as part of the Antenatal Screening Program, if the individual’s NHS or MRN number is not known their address must be used as the third identifier. In these cases, the first line of the address must also appear on the specimen container.