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Requisition forms for submitting clinical pathology testing, cytopathology or anatomic pathology are provided. In addition, custom requisitions are available by contacting client services or your account representative at 317.491.6000 or 1.800.433.0740. For submission of samples for consultative services, please use the appropriate special form located in the Anatomic Pathology section.

Requisitions are for either client/facility billing or for billing to the patient/insurance company. Please print the type of requisition needed and use the one appropriate for the requested billing type.  The highlighted fields at the top of the requisition indicate required information and must be filled out.

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Anatomic Pathology
Clinical Pathology

Anatomic Pathology

Autopsy - Hospital

Autopsy - Private


General Surgical Pathology

Gastrointestinal Pathology

Hematopathology (bone marrow)

Hematopathology (flow cytometry)

Hematopathology (molecular)

Histology Special Request Form

Immunohistochemistry Abs

Liver Pathology

Molecular Pathology Patient Bill Form

Molecular Patholgy Client Bill Form

Molecular Hematopathology

Neuropathology - Muscle

Neuropathology - Nerve

Ophthalmic Pathology

Path Consult

Platelet Electron Microscopy

Renal Pathology

Urological Pathology

All other anatomic pathology (general form)

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Clinical Pathology

Allergy Testing - Foods Requisition

Allergy Testing - Non-Foods Requisition


Clinical Pathology Laboratory Test Request

Colorectal Cancer Screening

CF 139 Requisition

LBC-LS Ratio

Guidelines for Manual Requisition Completion

Hematopathology (bone marrow)

Hematopathology (flow cytometry)

Hematopathology (molecular)

Hemostasis and Thrombosis Test Request

Maternal Serum Screening Requisition

IU Agreement Lab - Cytogenetics Cancer

IU Agreement Lab - Cytogenetics Blood

IU Agreement Lab - Cytogenetics Prenatal

IU Agreement Lab - Molecular Genetics Requisition

IU Agreement Lab - Consent&Policy for MoleGen Testing for Huntington's Disease

IU Agreement Lab - Pharmacogenetics Requisition

IU Agreement Lab - Transplant Immunology Lab (Brahmi)

IU Agreement Lab - Infectious Disease (Jones)

MH HLA Lab - General Transplant Immunology Requisition

Cerner Downtime Requisition

Cerner Downtime STAT Requisition

Standing Orders Requisition

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GYN Requisition

Non-GYN Requisition

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IUSM Department of Pathology and Laboratory Medicine

ARUP Consult - Physician Guide to Lab Test Selection and Interpretation

Mayo Medical Laboratories - Physician Clinical Resources

Lab Tests Online - A Public Resource on Clinical Lab Testing