Forms

Test Requisition Form - Please complete all fields on the top of the form.

New Client Form

UPMC Children's Hospital Test Requisition Form (FOR USE BY UPMC CHP STAFF ONLY!)
NOTE: This form was revised on 2/21/13; the changes include: please circle either PRE/POST at the top of the form to indicate if a specimen was drawn before or after treatment; BOLD test names represent tests that need to reach the laboratory within 4 hours of draw time; we require 10cc citrated whole blood maintained at ambient (room temperature) for Adenine Nucleotides test.