Determine the appropriate requisition form based on your request and complete the form in its entirety. All forms MUST BE SIGNED by the ordering physician and MUST INCLUDE the following:

• First and last name of ordering physician
• Complete name of the office/facility including address, phone number, and fax number
• Billing directives: will the physician’s office receive the bill or will the patient’s insurance company
• If the patient’s insurance company is to be billed, include updated demographic information as well as the contact information for the insurance company

Ship the specimen(s) along with at least one H&E slide, all other stained slides, the Surgical Pathology Report, and the results of all additional ancillary testing to:

• Couriers may be arranged for local shipments. Contact the Consultation Office for additional information.
• If your shipment originates outside of the Columbus area, reference UPS account number 17V569.