Test Code GYN Cytology Request Form Cytology, PAP (Thin
There are 3 ways to order HPV test on gynecologic cytology requisition: 1. Ordering physician requests reflex HPV testing whenever current Pap test is reported as atypical squamous cells of undetermined significance.
WPM Pathology Laboratory
More than one pap smear specimen may be placed in a bio-hazard bag. Please make sure that each specimen is properly labeled and accompanied by a properly filled out GYN Cytology requisition form. NOTE: CLIA regulations dictate that the following information must be recorded on the test request form: Patient name; Patient date of birth
Gyn Cytology • Requisition Northwest Regional Laboratory 13705 NE Airport Way, Ste. C PATIENT NAME Portland, OR 97230 Client Services (503) 258-6900 ... Cytology/AWL. Title: Gyn Cytology • Requisition Author: Kaiser Permanete Northwest Created …
2119 E. 93rd / L15 Cleveland, OH 44106 216.444.5755 or 800.628.6816 CLINICAL (CHECK ALL THAT APPLY TO GYN) ¨ Routine Exam ¨ Pregnant _____ wks ¨ Postpartum _____ wks ¨ ost P Menopausal
Form Revised 2/2010 Pilot Name: _____ State University of New York ... GYN ThinPrep PAP Test & HPV HR (age 30 and over) w/ Reflex HPV 16/18 [CERNER order as HPV HR Screen] ... Microsoft Word - CYTOLOGY REQUISITION FORM …
Gynecological Cytology Requisition Form . Note: Pap samples must be labeled with the patient's surname and date of birth or sample will be rejected. Requisition sections in red are required information, please complete form appropriately or sample may be rejected. Please see reverse for more detailed instructions.
• When ordering a Pap test on paper requisition - use form # 1280520A. • Complete the following required fields (shaded): – Diagnostic, Screening (low or high risk) box
Use e-DH electronic requisition Lab3186 - or - use form F312a Indicate LMP, and check the appropriate response box for the following: (currently on GYN hormones (estrogen/progesterone compounds), hysterectomy, postpartum,
Screening Cytopathology smears, cervical or vaginal, performed by automated system, with manual recsreening, requiring interpretation by physician.
An Advance Beneficiary Notice of Noncoverage form must be completed and attached for all Medicare patients. Ordering physician _______________________________________________