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Requisition Submission

Requisition Submission

PSMG Requisition Submission

A Pathology Sciences “Pathology Request" form or other pre-approved test requisition forms must be completed with pertinent history, clinical data, special tests requested, and the following information:

  • Patient Name/Address
  • Date of Birth
  • Sex
  • Last Menstrual Period (as applicable)
  • Clinical Information
  • Specimen Source/Site
  • Date of Procedure
  • Tests Requested
  • Physician Name/Address



Surgical (tissue) and Non Gynecological specimens taken from one patient, on the same day, should be listed on one requisition and sent in one transport bag. This allows us to number and track your specimens more efficiently once they are received at PSMG.



When specimens are received with (not previously agreed upon) NON-PSMG requisitions, the clinician will be contacted to insure PSMG was the correct testing facility.

Container Labeling

Container Labeling

Specimen Container Labeling (2 identifiers)

The College of American Pathologists (CAP) has issued instructions for patient sample identification. All specimens (including glass slides) must be labeled with the patient name and at least one of the following second identifiers which are unique to the patient:

  • Date of Birth
  • Hospital Patient Number
  • Social Security Number
  • Requisition Number
  • Accession Number
  • Unique Random Number


The primary container (innermost) that actually holds the specimen should have these two identifiers.

Other information, such as gender, source/site, date of procedure, or referring physician may be included, but do not qualify as a second identifier, as these are examples of identifiers that are likely to be shared by two patients on the same day.


BD MAX UVE transport tubes:

  • Do not obscure 2-D bar code at the bottom of the UVE tube. Label the UVE tube by writing directly on the tube, using the PSMG supplied blue labels. or cutting your label to fit exactly around the tube and not obscuring the bar code at the bottom

PSMG couriers are instructed only to pick up specimens displaying two identifiers on the specimen container.

Specimen Pick-up Preparation

Specimen Pick-up Preparation

Once the specimen has been placed in the appropriately labeled specimen container and the lid is securely tightened, place the specimen container(s) in the portion of the transport bag with the zip lock top. The transport bag must not be red; per state regulations red bags signify waste. The requisition, and any other accompanying paperwork, should be placed in the outside, open pocket.
Processing Delay's

Processing Delay's

The following specimen discrepancies may result in the specimen being held until confirmation via telephone or fax can be made:
  • Missing pertinent information on requisition (ie Clinician Name, Date of Service).
  • Specimen source/type is different from container to requisition.
  • Specimen received without an adequate requisition (electronic or paper).
  • Empty bottles received.
  • Specimens received in an inappropriate fixative (i.e. tissue in SurePath fixative, tissue in saline with no special testing request, etc.).
  • Different names on requisitions vs. patient demographic or billing information.
  • Use of a NON-PSMG requisition (Pathology Examination Request).
Rejection/Return of Specimen Causes

Rejection/Return of Specimen Causes

In rare circumstances, a specimen may be returned to the clinician. It is likely that a specimen will be returned for the following reason:
  • Patient name on the requisition and specimen do NOT match.
  • Less than two patient identifiers on the specimen container.
  • Containers which have leaked enough to possibly compromise or lose the specimen.
  • Slides received broken beyond repair.
  • Pap smear specimen received in an inappropriate fixative (formalin or prefer fixative).
  • Specimens received in a condition judged to be biohazardous: fluids in open containers or syringes with needles attached.
  • Specimen received by unauthorized persons under California law (specified by the Dept of Health and Human Services).
  •  Specimens that PSMG does not process and received by mistake.
Please contact us with questions or to request a specimen pick-up. 
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The CAP Certification Mark is a service mark owned by CAP and is used pursuant to a license from CAP.