Required Forms for Partner Centers
Payvand Clinical & Specialty laboratory has provided access to the forms required by the partner centers for sending information in order to maintain coordination in the documentation and received orders. So please download your sample before sending your samples and complete the relative information.
- Patient sample registration form and type of tests requested
- Registration form for medical genetics molecular tests
- Sample acceptance form for FISH test
- Consent to conduct molecular and genetic medical tests
- Registration form for Specialty tests
- CML patient information registration form for treatment monitoring (MRD) with quantitative BCR::ABL test
- Celiac Request form
- OCB information registration form
- Thrombophilia Disease Information form
- Pathology Request form
- Cytology request form
- Peripheral blood and bone marrow karyotype request form
- Peripheral blood karyotype acceptance form (for infertility-repeated abortion-premarital diagnosis-IVF)
- Acceptance Form (WES) Whole Exom Sequencing
- Acceptance form for Sperm DNA Fragmentation (SDFA)
- Paptest request form
- TDM request form
- Urine free Cortisol application form
- Adult Lead Form
- Children’s lead form
- Assessment form for patients suspected of infection
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