Histocompatibility Lab Testing Requisition Form - University of Utah ... - healthcare utah 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the Requester Information section. Include today’s date, your name, phone number, and location. Ensure all fields are completed accurately.
3. Next, complete the Patient Demographics section. This includes the person tested's full name, date of birth, sex, race, medical record number (MRN), social security number (SSN), hospital information, and physician details.
4. Specify the transplant type and provide a description of the recipient's diagnosis or disease. If applicable, include the recipient's name if they differ from the person tested.
5. Fill in the Testing Requirements section by marking appropriate tests needed for HLA typing and crossmatching. Be sure to indicate any special studies required.
6. Finally, review all entries for accuracy before saving or sending your completed form directly through our platform.

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