Request forms and transport of samples

Request forms must be completed adequately and legibly, with full patient details (including hospital number), clinical details, date of and reason for request, and tests required. Specimens or forms which have not been clearly identified may be rejected or returned.


Haematology, Chemistry – Purple form

Immunology – Green form

Blood Transfusion – Pink form

Microbiology – Blue form

Serology – Blue form

Cytology – Yellow card for diagnostic cytology, cervical cytology use form from Open Exeter or form HMR101

Histopathology –Yellow card

Download pathology request form (for use during Cerner downtime or if order not available on Cerner)

Pathology supplies email address:


Addressograph label may be used on the request forms, provided that a label is on every copy of the request form.

All samples must be sent to the laboratory in a sealed plastic bag, and be clearly labelled with the patient’s full name, date of birth, date of collection, hospital number, source (to return results to) and signature (initials).

Unlabelled or leaking samples will be discarded and the relevant medical officer or surgery will be informed. All blood samples from Hepatitis B patients and from suspected HIV positive (including high risk groups) should be labelled DANGER OF INFECTION.


Private patients

Private patient forms should be clearly marked with a tick in the box designated for private patients. All samples must be clearly labelled as PRIVATE. The patients address must be given on the request form for billing.

Transport of samples

Where appropriate use the pneumatic tube system to deliver the sample to Central Pathology reception at ESH (see Trust Policy for Transport of Pathology Specimens).

Where sample cannot be placed in pneumatic tube (see below) or system not available, arrange for delivery to Central Pathology reception. A portering service for the regular collection of routine samples from wards at the East Surrey hospital is in-place. These samples must be transported to the laboratory via the transport boxes.

Arrangements are in-place for samples to be collected from the GP surgeries and other units by the hospital transport services. To assist with the delivery of samples to the laboratory, Microbiology samples should be placed in the blue plastic bags, and all other samples should be placed in the red plastic bags.

Pneumatic Tube System

For detailed use of the Pneumatic Tube System, please see SASH Trust Policy for Transport of Pathology Samples.

The pneumatic tube system must NOT be used to transport the following sample types:

  1. Blood cultures
  2. Blood gases
  3. Clinical waste, used transfusion bags, plasma bottles, and radioactive waste
  4. Tissue samples for microbiology investigations
  5. Samples of cerbro-spinal fluid (CSF)
  6. Tissue for frozen section
  7. Cytotoxic drugs
  8. Tissue samples in formalin

The above items MUST NOT be sent in the Chute system. Instead please ensure delivery of these items directly to Pathology Reception.

Please remember to label all samples correctly and ensure that all lids are secured before sealing the sample bag ready for transportation.