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Specimens Submission Requisition Form Mobile App

The Specimens Submission Requisition Form mobile app was designed to help define how to submit surgical pathology and cytology specimens to the Pathology Departments and how to arrange for an autopsy examination. All Clinic, Operating Rooms and Pathology Personnel are responsible for completing the app. A completed requisition form must accompany each specimen and must have a minimum of two patient identifiers. The reports that GoCanvas provides online for all of our users can be found within the "Reports" tab in GoCanvas .

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Specimens Submission Requisition Form Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico statictext

    A completed requisition form must accompany each specimen and must have a minimum of two patient ...

  • Ico checkbox

    Affix a patient label or,

  • Ico checkbox

    if hand written, include the:

  • Ico checkbox

    patient’s full name

  • Ico checkbox

    hospital identification number (medical record number)

  • Ico checkbox

    encounter number (visit number)

  • Ico checkbox

    birth date

  • Ico checkbox

    hospital ward or clinic

  • Ico checkbox

    The clinical history provided must be accurate and complete in order for the pathologist to come ...

  • Ico checkbox

    List the differential diagnosis in the Pre-op diagnosis area

  • Ico checkbox

    The referring attending physician’s name and/or the name of the responsible physicians, as well a...

  • Ico checkbox

    Include pager numbers if you wish to be contacted with results or a fax number if you wish the re...

  • Ico checkbox

    List the specimen type (anatomic site) that corresponds to the specimen type listed on the specim...

  • Ico checkbox

    If the patient has an infectious disease (i.

  • ...and More!

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