Get Cervical Cytology Request Form - Cancercare

Filling out the CERVICAL CYTOLOGY REQUEST FORM is essential for ensuring the correct processing and examination of cervical specimens. This guide will provide you with step-by-step instructions on how to accurately complete the form online, ensuring all necessary information is collected.

Follow the steps to effectively fill out the form online.

1. Press the ‘Get Form’ button to access the CERVICAL CYTOLOGY REQUEST FORM. This will allow you to open and view the document online.
2. Begin by entering the 'date received' field with the current date in the format dd/mmm/yyyy. This information is crucial for record-keeping.
3. Fill out the 'patient information' section, including the patient's last name, first name, and PHIN (or military/other provincial/territorial number). Make sure the name on the specimen vial or slide matches exactly.
4. Document the specimen collection date and the last normal menstrual period date, both using the format dd/mmm/yyyy.
5. Provide details pertaining to the patient's history, including the last Pap test date, previous abnormal Pap test date, and whether the patient is pregnant or menopausal.
6. Enter the patient's date of birth and gender. These details help identify the patient correctly in the system.
7. Complete the 'previous treatment' section by indicating any past procedures like colposcopy or laser treatment, including relevant dates.
8. In the 'hysterectomy' section, specify whether the patient had a total or subtotal hysterectomy.
9. Select the type of specimen preparation, choosing between liquid based cytology or conventional cytology, and note the instruments used in the collection.
10. Complete the 'current treatment' section by specifying any hormonal treatments or contraception methods the patient is undergoing.
11. Fill in the details of the provider information, including the provider's last name, first name, and their CervixCheck/Provider number.
12. Specify the billing details, indicating whether the charges will be billed to a physician, physician assistant, nurse, midwife, or other.
13. Finally, review the completed form for accuracy, making sure all fields are filled out correctly. You can then save your changes, download the document, print it, or share it as needed.

Complete the CERVICAL CYTOLOGY REQUEST FORM online today to ensure prompt and accurate processing of cervical specimens.