PATIENT REQUEST FORM
To comply with good clinical practice it is important that there
is one request form for each patient's request, and specimens and
form are correctly and fully labelled, to include three unique
• First name, Surname, Date of birth, Hospital/Clinic number,
Medical Record Number (MRN) are examples of patient
• Time and Date of collection of samples
• Type of sample and Anatomical site, where appropriate (e.g.
• Relevant clinical information
• Relevant details of medication
• High Risk Samples should be clearly identified on the form and
individually packed separately from other samples
Please see here for more information on how to
complete the form.
• Hazard Group 4 pathogens (such as viral haemorrhagic fever)
must not be sent to the laboratory - if received, they will be
If additional tests are required for a sample already received
please contact us on 1800 303 349 with your request
for specific further analysis. Samples are stored within timeframes
according to their discipline. Laboratory staff will advise on the
ability to undertake further testing from samples already received
in the laboratory.