Please ensure that you select the requisition matching each ordered test.
Failure to complete the appropriate requisition may result in delayed processing and/or rejection of the sample.
The clinical indication for testing, sample type and clear identification of the authorizing provider must be indicated on the requisition to allow for appropriate and timely processing of the samples.
Laboratory requisitions
Standard Cytogenetic Requisition
For chromosome analysis, all FISH testing (including microarray follow up FISH testing) and RAD
Mandatory for all products of conception (POC), intrauterine fetal deaths (IUFD) and stillbirth samples referred for RAD/microarray testing. Also complete a Standard Cytogenetics Requisition. See shipping instructions.
Microarray and Microarray Follow Up Q-PCR Testing Requisition
For microarray and microarray follow up Q-PCR testing
Standard Molecular Requisition
For breast cancer, FMR1-related disorders, hemochromatosis, MCC, muscular dystrophy/atrophy testing, Prader-Willi/Angelman syndrome, thrombophilia, etc.
Cardiogenetics Testing Requisition
For ARVC, HCM, DCM, Pan-cardiomyopathy panels
Connective Tissue Disorder and TAAD Requisition
For Arterial Tortuosity, Loeys-Dietz syndrome, Marfan syndrome, TAAD panels
Forms
Consent to Disclosure of Personal or Health Information
License and accreditation
Certificate of accreditation from the Institute for Quality Management in Healthcare