Pathology Test Requests/Forms

Request for Pathology Consultation
Many of our pathologists specialize in specific areas of pathology and are available to provide consultation to outside pathologists or patients. To request a consultation, please send a letter detailing your request and any questions you may have with the slides and outside report. You should also send billing information, as we typically bill for these services.

Bronchoalveolar Lavage Requisition
If you would like to send us a specimen collected by bronchoalveolar lavage, please use our BAL Order Sheet. This can be printed, filled out, and returned to us accompanying the specimen. Additional instructions for specimen requirements and shipping are on the bottom of the form.

Renal Biopsy
If you would like to send us a renal biopsy specimen, please use the Laboratory Request form. Testing needs will be determined at Virginia Mason according to the patient's history and the adequacy of the specimen, but will include at least paraffin H&E sections, and may also include special stains, plastic embedding, immunofluorescence and/or electron microscopic evaluation. Ideally 3 or more tissue cores should be obtained. A portion should be placed in formalin fixative, part in IF Transport medium, and 1 glomerulus in Trumps Fixative. IF Transport media and Trumps can be obtained by calling the Virginia Mason Histology Department at (206) 223-6861. Each core for formalin and IF Transport medium should possess multiple glomeruli. Check with a dissecting microscope for proper specimen separation.

Skin Immunofluorescence
If you would like to send us a specimen for skin immunofluorescence, please use the Laboratory Request form. Take two biopsies or divide a single specimen and submit one in 10 percent neutral buffered formalin and the other in IF Transport media (provided in advance by Virginia Mason). Specimens in IF Transport media must be handled in five days or less for optimal results. IF media needs to be kept in a refrigerator at 2-8°C for optimal shelf life, but there is no need to refrigerate during shipping. IF media should be discarded if the expiration date has passed, the media is cloudy or has precipitated.

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Patient Request for Pathology Materials to be Sent for Second Opinion
If you would like your slides sent to another institution, for either a second opinion or because you will be receiving care there, please use the Patient release of information and Pathology Materials Review form. These forms can be printed, filled out, signed and faxed to (206) 341-0525. Once we have received these forms, we will forward the materials to the pathology office of the outside facility. You may be billed for this review by the outside institution. We do not charge for sending the slides.

Outside Institution Request for Pathology Materials to be Sent
If you are an outside institution requesting patient materials, you will need to send us a completed and signed Patient release of information form detailing the request. You may request either slides or blocks, but not both concurrently. Once we have received this request, we will forward the materials to the address noted on the request. We do not charge for sending the slides, but may charge for recuts or other requests.

Patient Release of Information Form
A signed copy of this form is required to allow Virginia Mason to release any information about you or your specimen, including reports, slides or blocks. Use this form to detail your request, and fax to (206) 341-0525.

Pathology Report Request
If you are looking for the results from your recent biopsy or surgery, you should contact your primary care physician who will have access to the report and can discuss the results with you, as well as any needed follow-up.

Autopsy Report Request
If you would like to receive a copy of a finished autopsy report, call the Pathology office at (206) 223-6861. Virginia Mason can fax a copy of this report to your doctor when we receive their request.

Add on test
To request that an additional test be performed on your tissue specimen, use our add-on request form. This can be printed, filled out, and faxed to us at (206) 341-0525.

For more information about the test requests and forms from Virginia Mason's Laboratory and Pathology Department, call (206) 223-6861.

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