/ / CUSTOM TEST REQUEST FORM - Regional Pathology ... 2026

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by filling out the Patient Information section. Enter the date requested, patient name, date of birth, and medical record number. Ensure all details are accurate for proper processing.
  3. In the Specimen Type section, select the appropriate specimen type to be drawn by checking the corresponding box. This is crucial for determining testing requirements.
  4. Provide Indications for Testing or ICD codes in section B. This information is necessary for insurance authorization.
  5. Complete the Insurance Information section by confirming that a clear copy of the insurance card is attached. If applicable, provide details about the policyholder.
  6. Fill out the Clinical Information section by attaching relevant clinical records that support your request.
  7. Finally, submit your form via email or fax as indicated at the bottom of the document. Use our platform's email button for convenience.

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Request for Pathology Investigation is a DIAGNOSTIC TEST REQUEST. A request for one or more investigations within a PATHOLOGY SPECIALTY, from a single sample, or group of related samples, taken from a PATIENT or other human or non-human source and sent to a pathology laboratory at one time.
If further investigation is needed, the doctor might order blood or other lab tests, or medical imaging. To arrange these tests, your doctor will need to fill out paperwork requesting the specific exam and explaining why they are needed. This order is called a requisition.
Pathology tests cover blood tests, and tests on , stools (faeces) and bodily tissues. A pathologist interprets the results of blood and pathology tests and looks for abnormalities that may point to disease, such as cancer and other chronic illnesses, or health risks, such as pre-diabetes.

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