Requisitions / Forms

Requisitions / Forms

Associates in Pathology uses two different requisition forms for cytology and surgical pathology as well as several other forms for different services.

It is important to fill out the requisition forms completely to reduce processing time and ensure a timely and accurate diagnosis.

Surgical Pathology Laboratory Order Requisition Form
For all tissue specimens obtained during inpatient or outpatient procedures. 

Cytology Order Requisition Form
For fluid-based samples such as endocervical scrapings suspended in Preserv-Cyt solution, urine, washes, lavages, CSF, cyst fluid, paracentesis, thoracentesis, etc. This form accommodates both gynecologic and non-gynecologic specimen types.

Used to request special tests outside of what is offered at Associates in Pathology.
 Used by physicians to request material for consults at AiP or at outside facilities.

Supply Form
Online form for cytology and pathology supplies.

Advanced Beneficiary Notice of Noncoverage (ABN)
The ABN is utilized when a routine pap smear is collected from a patient covered under Medicare. This form accompanies the Cytology Request Form completed for all pap smears. An ABN does not have to be provided when a physician submits a diagnostic pap smear or collects material from a high risk patient. An ABN is not necessary for patients not covered by Medicare.

Authorization for Disclosure of Protected Health Information
Online form for the release of patient medical records.