Department of Pathology

Instructions: Print and complete form* which will accompany sample(s) to be submitted. Each sample submitted must include the signature of an authorized ordering person and a diagnostic indication for the requested chromosome study. Follow this link for sample shipment information.

• STANDARD CYTOGENETIC ANALYSES REQUEST FORM
  (for constitutional/congenital chromosome and FISH studies)
  

• aCGH MICROARRAY REQUEST FORM
  (array platforms to detect constitutional gains and losses)

• ONCOLOGY CYTOGENETIC ANALYSES REQUEST FORM
  (for cancer chromosome and FISH studies)

• PRENATAL CYTOGENETIC ANALYSES REQUEST FORM
  (for amniotic fluid, chorionic villi, etc.)

Download the complete Specimen Collection Manual

Download Oncology Testing Recommendations

 

*Requisition forms are provided in pdf format and require Adobe Reader:

 

Research Requisition Form
(i.e., cell line characterization, animal cells, etc.)
Pre-approval required for all research requests: please inquire prior to submission

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