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Requisition Forms

General Pathology Form (covers breast, cytopathology, ENT, eye, GI & hepatopathology, urologic, pulmonary, renal and surgical)

Anatomic Pathology/Non-GYN Cytology Form
(includes tests for breast carcinoma markers, gastric/gastroesophageal carcinoma, colorectal carcinoma, lung carcinoma, melanoma/thyroid, gestational trophoblastic disease/molar pregnancy evaluation and UroVysion^™/urine FISH)

Consultation Form

Cytogenetics Forms

Congenital Cytogenetics & Microdeletion FISH Testing Requisition
(aka karyotyping for constitutional/congenital chromosome abnormalities and includes microdeletion FISH studies)
Oncology Cytogenetic Analyses Request Form
(for cancer chromosome and FISH studies)
Prenatal Cytogenetic Analyses Request Form
(for amniotic fluid, chorionic villi, etc.)
aCGH Microarray Request Form
(array platforms to detect constitutional gains and losses)

Clinical/Molecular Pathology and Endocrinology Form

Clinical/Molecular Pathology and Endocrinology Requisition
(includes endocrine autoantibody tests for autoimmune diabetes, autoimmune thyroid disease and adrenal cortical steroidal autoantibodies; special coagulation; hematopathology; and pharmacogenetics testing)

Head & Neck, Oral & Dermatopathology Comprehensive Services

Head & Neck, Oral & Dermatopathology Comprehensive Services Requisition
(includes skin, oral cavity, ear, nose, sinus, pharynx and larynx testing)

Clinical Toxicology

Clincal Toxicology Requisition
(includes comprehensive/benzodiazepine/opioid/ethanol biomarker panels; assays for amphetamines, barbiturates, cannabinoids, cocaine, heroin, muscle relaxants and hallucinogens; drug class screen; and specimen validity)

Gynecologic Pathology

Gynecology Requisition
(includes Pap tests; infectious disease testing; biopsy analyses; and urine cytology)

Hematopathology

Hematopathology Requisition
(includes flow cytometry; molecular studies; and cytogenetics/FISH analyses)

Podiatric Pathology

Podiatry Requisition
(includes skin/soft tissue, bone, nail and microbiology tests)

Dermatopathology

Dermatopathology Requisition
(includes direct immunofluorescence; slide consultations; and molecular studies)

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