Request & Release of Pathology Materials - CareMount Medical 2026

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The document is a request form for the release of pathology materials from CareMount Pathology. It includes sections for patient and specimen information, disposition of slides, and authorization signatures from both the patient and clinician. The completed form should be faxed to CareMount Pathology, and upon completion, the requested slides will be shipped via FedEx.
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  1. Click ‘Get Form’ to open the Request & Release of Pathology Materials in the editor.
  2. In Section 1, enter the patient's information including Name, CareMount MRN, Address, Date of Birth, City/State/Zip, and Phone number. Ensure all details are accurate for proper identification.
  3. Proceed to Section 2 where you will specify the Disposition of Slides. Fill in the Attn name, Institution, Address, and Phone number where the slides should be sent. Confirm the address with the consulting laboratory if necessary.
  4. In Section 3, provide authorization by signing and dating the form. If you are a clinician completing this on behalf of a patient, print your name and sign as well.
  5. Finally, leave Section 4 blank as it is for laboratory authorization only. Once completed, return the form via fax to CareMount Pathology at 914-302-8334.

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noun. the act of asking for something to be given or done, especially as a favor or courtesy; solicitation or petition: At his request, they left.

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Definitions of request. verb. express the need or desire for; ask for. She requested an extra bed in her room synonyms: bespeak, call for, quest call for, invite.

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