Forms

Select the form that you need:

• Chain of Custody Request Form
  Use this form to order tests that could be used in a court of law.
• Critical Values Notification
  Use this form to define contacts for critical values notifications.
• Maternal Screening Material
  Use this information and form to obtain certification for maternal screening.
• Patient Information and Signature Forms
  Use these forms when a test requires additional information or signatures.
• Add Tests to an Order
  Request additional tests after a specimen has been shipped.
• Test Setup Request
  Generate a spreadsheet containing the setup information for multiple tests, and use the spreadsheet to build ordering codes and test (result) codes into your laboratory information system (LIS).
• Request For Supplies
  Use this PDF if the Supplies ordering system is not available.

Manual Test Request Forms

If you order tests electronically through the MayoACCESS® or the MayoLINK® application, continue to order tests through those systems. If these applications are not available, use the following form:

• Downtime Form

If you order tests manually by submitting printed forms, use the following forms for specific tests.

• Allergen Test Request (T236)
• Benign Hematology Test Request (T755)
• Biogen Program Alzheimer's Test Request (T888)
• Cardiovascular Test Request (T724)
• Children's Oncology Group Test Request (T829)
• Coagulation Test Request (T753)
• Gastroenterology and Hepatology Test Request(T728)
• Hematopathology/Cytogenetics Test Request (T726)
• Immunohistochemical (IHC)/In Situ Hybridization (ISH) Stains Request (T763)
• Biochemical Genetics Test Request (T798)
• Iothalamate Test Request (T890)
• Microbiology Test Request (T244)
• Neurology Test Request (T732)
• Oncology Test Request (T729)
• Pathology Consultation Request (T246)
• Prostate Health Index (phi), Serum (T792)
• Renal Diagnostics Test Request (T830)
• Therapeutics Test Request (T831)
• Whole Exome Sequencing Test Request (T801)

If none of those tests apply, use the General Test Request (T239)

After completing and printing, send the form with your specimens to Mayo Clinic Laboratories.