Request Forms

 

Refer to Eastern Health Specimen Labelling and Identification Policy

 

Request Forms
Eastern Health Pathology provides a single form to be used for all tests. Information regarding the pathology test should be written clearly on the request form, and include -

• Adequate patient identification - a minimum of two identifiers is required eg name and UR number, name and date of birth.
• Tests requested
• Name and signature of requesting doctor and the request date
• Consultant if different to the requesting doctor
• Patient location
• Name, address (and telephone number, if possible) of additional doctors requiring copies of results
• Doctor's contact number, if results are to be telephoned. Fax number must be supplied if results are to be faxed.
• Relevant clinical details - this is a very important but often neglected part of the request form. Please be as specific as possible - all comments will help our pathologists and scientists to provide correct and precise results.
• Collector's signature
• Time and date of collection

View an example of a completed:

Standard Pathology Request Form and Blood Products Request Form

Patient Identification

Refer to Eastern Health Specimen Labelling and Identification Policy

• Incorrectly, inadequately or illegibly labelled specimens or request forms will not be processed until correction of the mislabelling by the collector within the pathology department.
• Incorrectly, inadequately or illegibly labelled specimens or request forms for blood bank purposes eg blood cross match or group and hold will not be processed under any circumstances.

Specimen Label Placement

Align with tube label	Do NOT place labels upside-down
Position patient name at lid end	Do NOT place labels on sideways
	Do NOT place labels covering barcodes
	Do NOT place labels covering window

Order of Draw

The following blood collection (vacutainer collection) order of draw is recommended:

• Blood Cultures
• Citrate, ACD, ESR
• Plain (Serum)
• Heparin
• EDTA
• Fluoride Oxalate
  

(Reference: NCCLS Order of Draw (NCCLS H3-05,Vol 23, No 32, 8.10.2)

Needle and Syringe

If venepuncture is completed using a needle and syringe, the following must be adhered to when using vacuum tubes.

1. Tubes with additives are filled first
2. Tubes must never be filled by injecting blood through the rubber stopper as this causes significant haemolysis
3. Replace stopper or cap firmly

Special Requirements

 

Many tests are valid only if the specimen is collected and handled appropriately. Specific collection, handling and storage requirements are listed in this handbook.

Note that specimens may give misleading results due to:

• Contamination - for example contamination of venous blood with intravenous fluid. Care should be taken to avoid contamination. Hospital inpatients with in situ I.V. lines are best not to be sampled from the arm with the I.V. but from the opposite arm.
• Haemolysis - which can be caused by excessive manual drawing on a syringe, or by use of a small-bore needle. Haemolysis will increase plasma potassium levels and interfere with some test analyses.

Extra considerations

• Avoid sending contaminated or leaking specimens or request slips.
• The laboratory will not accept blood gas syringes with the needle still attached. Collection staff will be contacted and asked to attend the laboratory immediately to remove the needle. Given the urgency of blood gas specimens, this leads to undue delay in producing important urgent results.
• Many tubes contain additives, which may affect test results. It is important to collect directly into the required collection tubes. Never transfer collected blood from one tube to another. This is especially important if the first tube contains anti-coagulant.