Cytology Requisition

A Cytology Requisition must be completed for all specimens. Include the following information on the request form for accurate specimen preparation, interpretation, result reporting, record keeping and billing. (Exclusion of any of the following information may result in specimen rejection and/or processing delays.)

1. Patient’s complete name, Geisinger medical record number (if any), other client specific patient identification numbers, date of birth, and sex.
   
2. Date specimen obtained.
   
3. Specimen type: Check the space next to the specimen type (e.g., cervical-vaginal, gastric brush, bronchial wash, etc.), and/or write in specific specimen source information. If the specific test required does not appear on the paper requisition it is important to "write in" the desired test. For example it may be necessary (as new requisitions may not have reached all sites) to write in "Thin-layer with HPV if ASCUS" if a thin-layer analysis with reflexive HPV-DNA testing is desired in the event of an ASCUS result.
   
4. Complete patient history: For gynecologic specimens, this includes the last menstrual period, pregnancy history, hormonal therapy, clinical findings such as abnormal bleeding or discharge, IUD use, and previous procedures such as biopsy or cryotherapy and prior pap results. (NOTE: For gynecologic specimens, omission of LMP will result in a "Satisfactory but limited by lack of menstrual history" under the assessment of adequacy.)
   
5. Name of caregiver: Clearly state the name of the caregiver and how that individual may be contacted if additional information is required or results need to be reported by phone.
   
6. Billing Encounter number (on a customized request for a contract account, this will be imbedded in requisition).

Adopted MKurtinecz, 12/04
Reviewed MKurtinecz, TSp 12/04
Reviewed MKurtinecz,TSp 1/06
Reviewed MKurtinecz,TSp 5/07
Reviewed: MKurtinecz, TSp 7/08
Reviewed: MKurtinecz, TSp 8/09