Test Requisitions

The client should complete a Requisition for each patient for whom specimens are submitted to MLabs. An MLabs client code and location code are pre-printed on all requisitions in order to direct reports appropriately and keep your patient’s uniquely identified in our Laboratory Information System. If you are not an established client and sending a specimen for the first time, please contact the MLabs Client Services Center for instructions. A number of specialized requisitions are available and it is important to choose the right one for your requested testing. Pathologists or other physicians referring slides and/or blocks for consultation should use the Anatomic Pathology Consultation Requisition.

	Allergen Requisition    This requisition may be used to specify MLabs IgE allergen or allergens to be tested.
	Anatomic Pathology Consultation Requisition This requisition is for use by Pathologists or other physicians referring slides and/or blocks for consultation.
	Cystic Fibrosis (CF) Requisition This requisition should accompany specimens sent for Cystic Fibrosis screening, diagnostic mutation detection, and other molecular genetics testing.
	Constitutional Cytogenetics Requisition This requisition may be used to order chromosome analysis for constitutional disorders.  Please use the Hematopathology Consult Requisition to order cytogenetics testing for malignancy.
	Dermatopathology Requisition This requisition should accompany specimens sent for Dermatopathology.
	Hematopathology Consult Requisition This requisition may be used by Pathologists or other physicians to accompany specimens (e.g., bone marrow, peripheral blood, fresh tissue, body fluid) sent for Hematopathology consultation. Please use the Anatomic Pathology Consultation Requisition when sending only slides and/or blocks.
	Histocompatibility Requisition    This requisition should accompany specimens sent for Histocompatibility.
	Hospital Requisition This requisition includes testing commonly ordered by hospitals.
	MCTP Test Requisition This requisition can be used for sending testing performed by the Michigan Center for Translational Pathology (MCTP) Molecular Testing Laboratory, which includes PCA3, MiPS, and Circulating Tumor Cells by CellSearch. A signed Advance Beneficiary Notice of Noncoverage (ABN) form must accompany any samples sent for PCA3 or MiPS testing from Medicare patients when MLabs will be billing Medicare or the patient.
	MMGL BRCA Requisition   This requisition should accompany specimens sent for BRCA testing performed by the Michigan Medical Genetics Laboratories (MMGL) Molecular Genetics Laboratory.
	MMGL Molecular Genetics Requisition This requisition should accompany specimens sent for testing performed by the Michigan Medical Genetics Laboratories (MMGL) Molecular Genetics Laboratory.
	Molecular Diagnostics Requisition This requisition includes an expanded menu of Molecular Diagnostics assays. Complete and submit this form with all requests for the Cystic Fibrosis Mutation Detection or other molecular diagnostics assays.
	Physician Office Requisition This requisition includes testing commonly ordered by physician offices.
	QUAD / AFP Requisition Complete and submit with all requests for the Quad Test Profile or Alpha Fetoprotein, Serum, Maternal.
	Surgical / Cytopathology Requisition This requisition should accompany any surgical or cytological specimens, including Muscle, Nerve, or Renal biopsy specimens. Be sure to fully complete all portions of the relevant section.