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Request Forms

Use the buttons below to download the appropriate request form. If you can't find what you're looking for, please get in touch. We ask that the forms are completed in full and, if handwritten, written in block capitals. Missing information could lead to delay in testing as some information is vital in order for a case to be booked in. 

To minimise the risk of transcription or duplication errors, we recommend downloading a fresh copy of the request form for each referral made

Request requirements

The use of patient ID stickers is permitted, however, please ensure you use the full patient sticker and NOT the smaller blood tube sticker. All specimens received into MPDS must meet the agreed laboratory minimum data set; any specimens not meeting the criteria may be returned to the requesting department. Please ensure that any important information (e.g. clinical history, etc.) is clearly indicated on the form and ensure that any priority or urgent cases are marked as such.

Where possible a copy of the pathology report should be provided.

Shipping requirements

It is the responsibility of the sender of the specimen to arrange safe and appropriate packaging and transport of specimens that meets national/international regulatory requirements for the transport of biological specimens. If multiple patients are being sent in a single package then these should be separated individually within the package and referral forms attached to each individual specimen container. Blocks from different patients should not be kept in direct contact with one another.

 

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Transport from external sources

It is the responsibility of the referring centre sending the specimen to arrange appropriate transport to MPDS. We recommend that all samples posted are sent via recorded/tracked delivery. QEHB are not responsible for any samples that go missing between the referring centre and QEHB.

Transport of Specimens at QEHB

It is the responsibility of the department sending the specimen to arrange appropriate transport to MPDS. This can either be through the internal post system or hand delivered. If a sample is being dropped off at the CLS Specimen Reception, we ask that you contact the Molecular Specimen Reception on Ext: 13325 to alert us that the sample has arrived.

 

Hazardous Specimens

Specimens arising from patients with known or suspected transmissible diseases (e.g. tuberculosis, viral hepatitis, HIV) must be clearly labelled as such and packaged appropriately to prevent unnecessary risk to laboratory staff. 

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Copyright UHB Pathology 2018

Protection of Personal Information – Clinical Laboratory Services comply with the Trust Data Protection Policy and have procedures in place to allow the Directorate and it’s employees to comply with the Data Protection Act 1998 and associated best practice and guidance.

University Hospitals Birmingham medical laboratories at Queen Elizabeth Hospital, Heartlands Hospital, Good Hope Hospital and Solihull Hospital are UKAS (United Kingdom Accreditation Service) accredited to the ISO 15189:2012 standard. For a list of accredited tests and other information please visit the UKAS website using the following link: https://www.ukas.com/find-an-organisation/

  • Molecular Pathology is a UKAS accredited medical laboratory No. 8759
  • Biochemistry is a UKAS accredited medical laboratory No. 8910
  • Haematology and Transfusion is a UKAS accredited medical laboratory No. 8784
  • Clinical Microbiology is a UKAS accredited medical laboratory No. 8760
  • Cellular Pathology is a UKAS accredited medical laboratory No. 10141
  • Musculoskeletal laboratory is a UKAS accredited medical laboratory No. 9897
  • Heartlands, Good Hope and Solihull Hospital pathology laboratories are a UKAS accredited medical laboratory No.8217.

Tests not appearing on the UKAS Schedule of Accreditation currently remain outside of our scope of accreditation. However, these tests have been validated to the same high standard as accredited tests and are performed by the same trained and competent staff.

For further test information, please visit the test database: http://qehbpathology.uk/test-database

For further information contact Louise Fallon, Quality Manager, 0121 371 5962