Pathology Request Form - fairview 2026

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  1. Click ‘Get Form’ to open the Pathology Request Form in the editor.
  2. Begin by entering the patient's information in the 'Patient Data' section. Fill in the patient's name, date of birth, address, and contact number. Ensure all details are accurate for proper identification.
  3. In the 'Referring Physician' section, provide the physician's full name and UPIN. This is crucial for communication regarding the specimen.
  4. Next, complete the 'Specimen Information' section. Specify the specimen source and collection date/time. This helps in tracking and processing samples efficiently.
  5. Fill out the 'Clinical Information' area with pertinent clinical history, including ICD-9 codes or diagnosis as required by JCAHO.
  6. Select any requested studies from the options provided. Check all that apply to ensure accurate processing of your request.
  7. Finally, complete the billing information section accurately to avoid delays in processing. Specify primary and secondary insurance details as needed.

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How do I obtain these slides? Call the hospital where your biopsy or surgery was performed or where the tissue was sent. In most cases, you will speak to a pathology department. The pathology department may request that you sign a release for the slides.
Getting a copy of your pathology report You can contact your medical provider to help you get a copy of your pathology report. Procedures for obtaining medical records vary from state to state, and from facility to facility. You may have to pay a fee for your report.
How long is a pathology request valid for? Pathology Referral forms can be used up to 12 months from your consultation.
Pathology tissue biopsies take approximately 48 hours to process and make into glass slides to be reviewed by the pathologist. Additional tests may be necessary on the tissue to make a final diagnosis. From the time of your surgery to the time the results are available to your doctor is usually 5 to 7 days.
In general, a period of 10-20 years is a lower-limit guideline for retention. Major institutions prefer to store their slides and tissue blocks for 10 years, whereas cancer referral centers preserve them for 25 years [1].