The Pathology Lab provides several standard application forms for the various examinations, for internal and external use.
To avoid errors and possible delays, these forms should be used.
They can be ordered from the Pathology Lab's GP ordering list.

Types of application forms

  • Histopathological test: can be obtained from the Pathology Lab. Blue for external physicians
  • Cervicovaginal cytology test: can be obtained from the Pathology Lab. Green for external physicians
  • Combined application for Histopathological and cervicovaginal examination: can be obtained from the Pathology Lab. Pink forms for external physicians


Recommendations on filling out the application form

The following information must be mentioned on the application form:

Administrative data:

  • Name, first name, date of birth, address, mutual fund information of the patient (cf. mutual fund insurance sticker)
  • Name, first name, address, NIHDI identification number of the requesting physician (cf. stamp)
  • Signature of the requesting physician
  • Application date
  • Any colleagues a copy of the report should be sent to

Information related to the tissues:

  • Type of test (biopsy, cytology,...)
  • Date and time of collection
  • Anatomical location: organ, location in the organ, laterality
  • Clinical information, antecedents, prior therapies, reason for tissue collection, differential diagnosis, specific question...
  • It is the responsibility of the requesting physician to ensure the application is complete.



Urgent tests:
Select separate tick box for 'urgent' tests. If the tissue was collected before 12:30, the tissue will be processed on a priority basis and the result will be given to the requesting or treating physician by telephone around noon the next business day. Please mention the name and phone number of the clinician to be contacted.
If the tissue was collected after 12:30 PM, the result is available two working days later, to allow for proper fixation of the tissue.

Contamination risk
Potential for contamination (e.g. TB, Hepatitis, HIV,...) should be clearly stated by the applicant on the application form.

Wrong identification
Applications may be rejected by the Pathology Lab if they contain insufficient or incorrect data to obtain a result that meets the applicable quality criteria. In that case, the laboratory will notify the applicant and record the non-conformities in the LIS. The non-conformity is also mentioned in the report.
If a sample is identified incorrectly, a staff member of the Pathology Lab will contact the requesting party.