This requisition may be used to specify MLabs IgE allergen or allergens to be tested.  

This requisition may be used to order chromosome analysis for constitutional disorders.  Please use the Hematopathology Consult Requisition to order cytogenetics testing for malignancy.

This requisition should accompany specimens sent for Cystic Fibrosis screening, diagnostic mutation detection, and other molecular genetics testing.

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.

This requisition can be used for sending testing performed by the Michigan Center for Translational Pathology (MCTP) Molecular Testing Laboratory, which includes PCA3, MPS (MyProstateScore), and Circulating Tumor Cells by CellSearch.

A signed Advance Beneficiary Notice of Non-coverage (ABN) form must accompany any samples sent for PCA3 or MPS testing from Medicare patients when MLabs will be billing Medicare or the patient.

This requisition should accompany specimens sent for BRCA testing performed by the Michigan Medical Genetics Laboratories (MMGL) Molecular Genetics Laboratory.

This requisition should accompany specimens sent for testing performed by the Michigan Medical Genetics Laboratories (MMGL) Molecular Genetics Laboratory.

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.

Complete and submit with all requests for the Quad Test Profile or Alpha Fetoprotein, Serum, Maternal.

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.