Latestbanner1.gif (19523 bytes)

BIOCHEMISTRY ONLY - TEST 'ADD-ON' FORM

HAEMATOLOGY TESTS (INCLUDING D-DIMER) MUST NOT BE REQUESTED VIA THIS SYSTEM - YOU MUST PHONE 1241 SO WE CAN CHECK THERE IS A SUITABLE SAMPLE
Microbiology tests (Hep B, HIV, etc.) - please contact Microbiology (x3557) - do not use this form.

SAMPLES ARE USUALLY KEPT FOR 3 DAYS. You can use this form 24/7 and you only need to contact us if required URGENTLY outside of core hours (8am to 5pm; Monday to Friday) on 7070.
Most 'routine' biochemistry tests can be added on. Please note exceptions:
Some tests must be analysed within a short time after collection e.g. drug levels, steroid hormones and cannot be added on. PTH can only be added to a EDTA (Pink Top) sample.
Some 'non-routine' tests will not be analysed unless they meet specific criteria and adequate clinical details are provided - see non-routine tests

Please note that from 2nd May 2013
Haematinics (Vitamin B12, folate) will no longer be added
due to stability issues.
Troponin T cannot be analysed on haemolysed samples. Date and Time of onset of symptoms must be given.
Patient details (all yellow fields are mandatory - can put 'unknown')

1st 3 characters of patient surname

Firstname  

Hosp./NHS/A&E No.  

Date of Birth  

 Test(s) to be Added (mandatory)
 

 Clinical Details / Other Information (essential for non-routine tests and drug levels)
 

 Requester Contact Details (mandatory)

Your Name:  

Bleep/Tel No  

i PLEASE NOTE: YELLOW FIELDS ARE MANDATORY. If left blank a 'Page Cannot Be Found' error is displayed and the request will not be sent (use back button to re-try).

Please use appropriately