Sending us samples: Request forms and guidance

Forms

• Cellular Pathology Request Forms
  • Histopathology Request Form for NuTH Users
  • Histopathology Request Form – Guidance for Completion
  • Diagnostic Cytology Request Form (non-Gynae) – please contact laboratory for request form
  • Frozen Section Guidance to Theatres
  • The PROCESS for labelling tissues specimens
  • Histopathology Request Form for External Referrers
  • Guidance for sending external referrals to NuTH Cellular Pathology
• Guidance for sending renal biopsy referrals
  • Instructions for sending renal biopsies
  • Guidance on use of Michel’s Medium for Immunofluorescence Specimens
• Requests for Post-Vasectomy Semen Analysis
  • Post-Vasectomy Semen Analysis Request Form
• Requests for Electron Microscopy
  • Electron Microscopy Request Form – Electronic
  • Electron Microscopy Request Form – Printable
  • Guidance for sending non-renal EM samples
• Requests for Mortuary Services
  • Newcastle upon Tyne Hospital Release Form
  • Request and Consent for Mortem Examination
  • Deceased Patient Record Form
  • Pregnancy loss transfer form
• Policies
  • Cellular Pathology Turnaround Times

Referring tests to us (non NuTH hospitals)

Please ensure that the test you require is available in our staining repertoire.

For laboratories outside of North East, North Cumbria (NENC) please contact the laboratory before sending the test, unless a formal arrangement is already in place.

• Requests for Her2 4B5/ISH
  • Instructions for sending Her2 cases
  • Her2 request form – electronic
  • Her2 request form – printable

• Requests for HPV16 ISH
  • HPV request form – electronic
  • HPV request form – printable
• IHC stain only referrals
  • Request form
  • IHC/ISH repertoire
  • Guidance for sending stain only referrals
• Lung mutation testing
  • Guidance for sending lung mutation requests
  • Lung mutation testing form – electronic
  • Lung mutation testing form – printable
• Melanoma BRAF Mutation requests
  • Melanoma BRAF Mutation request form – electronic
  • Melanoma BRAF Mutation request form – printable
• Sending cases for MSI/MMR
  • Request form – electronic
  • Request form – printable

Referring tissue samples to us

• Medulloblastoma Samples
  • Medulloblastoma Referral form

• Muscle biopsies
  • Sending frozen muscle biopsies
  • Advice on muscle biopsies
  • Muscle biopsy request form
  • Open muscle biopsy request form
• Nerve biopsies
  • Advice on sending nerve biopsies
  • Nerve biopsy request form
• Placenta referrals
  • Placental referral form
  • Placental pathological examination RCPath indications for referral (aide memoire for clinicians)
  • National guidance – G108 Tissue pathway for histopathological examination of the placenta
• Referred perinatal post mortems
  • Perinatal post mortem referral and consent form
  • Perinatal autopsy information leaflet
  • Perinatal post-mortem NHS England policy criteria for referral (aide memoire for clinicians)
  • NHSE Statement: perinatal post-mortem investigation of fetal neonatal deaths October 2022.