Requisition Information:
If more than 6 specimens are submitted for one patient, two separate requisitions must be completed.
The following information must be provided in a legible format:
Patient Information:
- Patient’s first and last name
- Date of Birth (DOB)
- Gender of patient
- Health Care Provider Information:
* Full name, address and billing number of the ordering health care provider - ICD-9 Code
- Collection Date and Time
- Physician Name
- Type of specimen (body site)
Pathology Requisition
Specimen Handling and Transportation:
- Specimens for routine tissue pathology must be submitted in a container of 10% neutral buffered formalin (biopsies for examination by direct immunofluorescence techniques must be submitted in a special transport medium [Michel Transport Medium or Universal Fixative]).
- Specimens collected from multiple sites must be collected in separate containers with the anatomic site indicated.
- Specimen container(s) must be tightly sealed to ensure safe handling and quality patient results. Leaking specimen container(s) may result in poor fixation, illegible labeling and lost tissue samples.
- Each specimen must be placed into a “Histology Specimen” polybag.
- The completed requisition must be placed in the separate pocket of the poly bag for this purpose (separated from the specimen container).
- Specimens must be stored at room temperature and must not be subjected to freezing or extreme temperatures.
Specimen Labeling:
All specimens should be clearly labeled BEFORE being sent to the laboratory for testing, to ensure correct identification of the patient and sample.
Each specimen/container must be labeled with:
- The patient’s full name (printed in the same format as patient’s health card)
- A second identifier such as date of birth or health card number
- Anatomic site of origin of the specimen
Specimen/container labeling options:
- Computer printed label affixed to the side of the specimen container.
- Clearly printed handwritten information on the sample vial label using indelible ink
Histology Collection Kit:
The optimum volume of fixation is 10-20 times of the specimen volume. There are two sizes of specimen containers routinely available for histology. Kit components are ordered separately:
- 90 ml sterile container with 40 mL of histology preservative (10% neutral buffered formalin)
- 20 ml sterile container with 10 mL of histology preservative (10% neutral buffered formalin)
- Poly bag
- Requisition form (ordered separately)
Acceptance / Rejection of Specimens:
1 . Specimens are accepted only if collected by appropriate means in Buffered Formalin or Michel’s Fixative and under the direction of a physician or his/her designee. No fresh specimens, body fluids, or blood samples will be accepted by this laboratory.
2 . Upon receipt, specimens are checked for proper labeling and accompanying paperwork.
3 . All surgical specimens MUST be accompanied by a legible requisition form.
The submitting surgical suite, physician office or clinic is called for information that is not written on the order form.
4 . Criteria for REJECTION of a specimen are:
- Specimen is not labeled and/or accompanied by a completed requisition.
- The name or other identifying information on the requisition does not match that provided on the specimen container.
If name on surgical specimen does not match those on the requisition, attempts are made to verify correct name (i.e., maiden/married name). Verification is documented on the requisition form and included in gross dictation (correct information, person providing information, date information was received, and name of person accepting the information).
5. Specimen container is empty or insufficient for processing.