Referral requirements & referral forms

A fully completed HMDN – Molecular Diagnostics and Flow Cytometry or Solid Tumour request form should accompany each sample. These should be legible and fully completed with all relevant information, including:

• Patient name (first and surname)
• Date of birth
• Address and post code
• NHS number
• Referring consultant (surname in full) department and referral centre* (where the report is to be addressed)
• Referring doctor’s contact telephone number
• Name and signature of person taking sample
• Relevant clinical details and test(s) required.
• Most recent FBC if possible
• Specimen type
• Date of sample collection

If a sample is a known infection risk please ensure this is recorded on the referral card. Indicate the risk with as much detail as possible and contact the department in advance. See High Risk Samples page for containment levels.

*Clearly stating the referring clinician and the referral centre is necessary to ensure the resulting report is sent to the correct location. Failure to provide this information may delay testing or result in the report being sent to the incorrect location. This information is also essential to ensure that referral centres are invoiced for the correct tests.

Please click here for the NUH Solid Cancer Genomic Test Order Form.

Blood and Bone marrow samples should be sent in an EDTA container. For specific sample volumes depending on the specific request see services and tests available.

All samples should be labelled with at least three patient identifiers which should also match on the referral card. For example:

• Patient name
• Date of birth
• NHS/hospital number
• Address

The sample should also state the date of collection and be accompanied by a completed referral card. Referrals should be sent to the Molecular Diagnostics department as soon as possible and within 72 hours. For sample transport information including storage before dispatch please refer to Transportation of samples.

Consent is assumed by the signing of the request form by the clinician. Clarification of consent would be sought if the form was not signed.

If the sample or referral card is inadequately labelled it may lead to rejection of the sample. For referrals that are not easily repeatable and are not adequately labelled, or are suboptimal*, processing may be attempted. The final report will include an explanation of the labelling of the sample and referral card on receipt in the laboratory. Samples in the wrong tube may be rejected, please see services and tests for specific sample type acceptance and rejection criteria.

High risk samples will be rejected if they cannot be handled at our containment level. See high risk samples page for containment levels.

*Suboptimal may include small samples, those delayed in transit, those not stored correctly and specimens received in the wrong container.

Page last updated 01/02/2024. Please note that if printed, this information is only valid on the day of printing.