Forms & Resources

Tube and urine collection charts are provided for quick reference for the most commonly ordered tests. The tube charts are 11x17 size and can be downloaded and printed. These work aids are also available by calling Client Services at 317.491.6000.

Collection Containers

• CT-NG-TV-MG (PDF)
• Microbiology (PDF)
• Special Coag (PDF)
• Urine (PDF)
• 24 Hour Urine (PDF)

Order of Draw

• Blood Collection Tubes (PDF)
• Microtainer Tubes (PDF)

Critical Values (PDF)

• Hematology Reference Ranges (PDF)
• Chemistry Laboratory Reference Ranges (PDF)
• Microbiology, Serology and Virology Reference Ranges (PDF)
• Thrombosis and Hemostasis Reference Ranges (PDF)
• Coagulation Pediatric Reference Range (PDF)

Therapeutic Ranges in Thrombosis & Hemostasis (PDF)

• IU Health Providers (PDF)
• Outreach Clients (PDF)

• Flow Cytometry (PDF)
• Hemostasis and Thrombosis (PDF)
• Pap Test Collection Rovers Device (Video)
• Pap Test Collection: Brush and Spatula (Video)
• Patient Instructions (PDF)
• Transfusion Medicine (PDF)

• Venipuncture
• Pediatric Venipuncture
• Blood Culture Sample
• Pediatric Blood Culture Sample
• Neonatal Heelstick
• Pediatric Fingersticks and Heelsticks

Specimen Identification and Labeling (PDF)

Specimen Transport (PDF)

• Advance Beneficiary Notice of Noncoverage (ABN) (PDF)
• Advance Beneficiary Notice of Noncoverage (ABN) Spanish (PDF)
• Critical Values - Call Contact Information (PDF)
• New Test Request (PDF)
• Patient Test Management Document (PDF)
• Physician Diagnosis Change (PDF)

• Autopsy - Hospital (PDF)
• Autopsy - Private (PDF)
• Dermatopathology (PDF)
• General Surgical Pathology (PDF)
• Immunohistochemistry Abs (PDF)
• Molecular Pathology Patient Bill Form (PDF)
• Molecular Pathology Client Bill Form (PDF)
• Neuropathology - Muscle (PDF)
• Neuropathology - Nerve (PDF)
• Ophthalmic Pathology (PDF)
• Path Consult (PDF)
• Platelet Electron Microscopy (PDF)
• Renal Pathology (PDF)
• Urological Pathology (PDF)
• All Other Anatomic Pathology (General Form) (PDF)

• Allergy Testing - Foods Requisition (PDF)
• Allergy Testing - Non-Foods Requisition (PDF)
• Clinical Pathology Laboratory Test Request - Patient Bill (PDF)
• CF 139 Requisition (PDF)
• Guidelines for Manual Requisition Completion (PDF)
• Hematopathology (Bone Marrow) (PDF)
• Hematopathology (Flow Cytometry) (PDF)
• Hemostasis and Thrombosis Test Request (PDF)
• Maternal Serum Screening Requisition (PDF)
• IUAL - Cytogenetics Cancer (PDF)
• Cytogenetics Blood Laboratory - IUAL (PDF)
• Cytogenetics Prenatal Laboratory - IUAL
• Molecular Genetics Laboratory - IUAL (PDF)
• Huntington's Disease Consent Form
• Biochemical Genetics - IUAL (PDF)
• Pharmacogenomics Requisition - IUAL
• Transplant Immunology, MH-HLA Laboratory - IUAL (PDF)
• Cerner Downtime Requisition (PDF)
• Cerner Downtime STAT Requisition (PDF)
• IU Health Micro department-specific clinical requisitions for the in-house and send-out tests (PDF)

GYN & Non-GYN Requisition (PDF)

• Establishing Medical Necessity for Lab Tests & Services (PDF)
• Reflex Testing (PDF)