Further Information:

Requisition

If an EPIC order is not used, the Cytopathology requisition form must be completed with the following information:

Name and location of the referring clinician

Source of specimen, include side and/or lobe, if applicable

Specimen collection date.

Patient demographics: name, address, gender, and date of birth

Test(s) ordered

ICD-10 code (reason for test)

Significant patient history

For thyroids- if reflex for molecular is needed, indicate test type (Thyroseq, Afirma, Quest) and reflex conditions. A separate requisition for Thyroseq and Afirma must accompany the vials.

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