Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to access the Histology Requisition Form and open it for editing.
2. In the 'Requisitioning Clinics / Practitioner' section, enter the name and address of the clinic or practitioner who is ordering the test.
3. Provide the clinician or practitioner's contact number for urgent results, ensuring the correct format for the phone number.
4. Fill in the health card number of the patient, along with their CPSO or registration number.
5. Complete the patient information section, including the patient's first and last names as per the health card, date of birth, sex, and health card expiry date. Make sure all entries are accurate.
6. Indicate the specimen collection date and time by using the provided fields. Select AM or PM as appropriate.
7. Specify the type of biopsy by checking the appropriate box (e.g., excision, shave, punch, etc.), and provide any necessary details in the anatomic site of biopsy field.
8. Enter the clinical history and gross description in the respective sections, ensuring clear and concise information is provided.
9. If applicable, include any additional identification in the laboratory use only section, including prof. and diagnosis codes.
10. Finally, ensure that the clinician or practitioner signs the form and includes the date. Review all filled entries for accuracy.
11. Once completed, save changes to the form. You can then download, print, or share the form as required.

Complete your Histology Requisition Form - Gamma-Dynacare online today for efficient specimen processing.