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 patient identifiers:

• First name, Surname, Date of birth, Hospital/Clinic number, Medical Record Number (MRN) are examples of patient identifiers
• Time and Date of collection of samples
• Type of sample and Anatomical site, where appropriate (e.g. swabs)
• 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 destroyed

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.

 

MLP standard request form        MLP Genetic Req THUMB        Genetic Req Con Form THUMB
 MLP Standard Request Form    MLP Genetic Request Form    MLP Genetic Request Form (cont)
         
 Supplies re-order form    MLP Demonstration form    
MLP Private Cyto form THUMB
 MLP Supplies Re-order Form    Demonstration Form  

 MLP Private Cervical
Cytology Request Form