Get Canada Cervix Check Cervical Cytology Request Form 2024-2025

Completing the Canada Cervix Check Cervical Cytology Request Form online is essential for accurate laboratory processing of cervical cytology specimens. This guide provides step-by-step instructions to ensure you fill out the form correctly and efficiently.

Follow the steps to complete your form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the accession number in the designated field to track the specimen throughout the laboratory process.
3. Enter the date received, ensuring you use the format dd/mmm/yyyy, to log when the laboratory receives the specimen.
4. Provide the specimen collection date, also using the dd/mmm/yyyy format, to note when the sample was taken.
5. Complete the patient history section with relevant information, including the patient's last normal menses, full name, PHIN, and MB Health number.
6. Include the last Pap test and previous abnormal Pap test dates, using the dd/mmm/yyyy format, to provide important medical context.
7. Indicate any relevant patient conditions, such as pregnancy or menopause, by checking the appropriate options.
8. Fill in the date of birth and gender, ensuring to match the information on the vial where applicable.
9. If applicable, list previous treatments such as colposcopy or knife cone, and their dates, for additional context on the patient's history.
10. Indicate if a hysterectomy has occurred and specify the type, selecting from total or subtotal options.
11. Select the appropriate specimen preparation method from the options provided, ensuring accurate categorization.
12. For present treatments, indicate hormonal treatments and specify any instruments used for the procedure.
13. Fill in the comments section if there are additional notes or considerations regarding the specimen or patient.
14. Complete the specimen collector information, including the name and designation, ensuring the correct identification of the individual collecting the specimen.
15. Indicate the billing details, including sending the report to the correct address and the necessary billing numbers.
16. Once all sections are completed, review the form for accuracy and then save changes, download, print, or share the form as needed.

Complete your Canada Cervix Check Cervical Cytology Request Form online today to ensure timely and accurate processing.