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Request forms and vials

Request form

The request form should be completed in full with all information PRINTED legibly or a printed label containing patient demographics can be used. The Manchester Cytology Centre supports the use of the electronic HMR101 request form that can be downloaded from Open Exeter. Please print off the form and complete it paying particular attention to the provision of relevant clinical history. Information relating to previous histology biopsies (punch, LLETZ/loop, cone etc) with histology grade and date of biopsy, as well as details of any treatment are ESSENTIAL to ensure correct patient management is given.

Electronic requesting

Cervical screening tests can be requested electronically via a system called ICE allowing the sample taker to provide all the relevant mandatory information.

NHS number

The NHS number MUST be used whenever it is available as this is the unique patient identifier. The NHS number will be a mandatory requirement for electronic requesting. In addition, the full forename, surname and date of birth MUST be given.

PIN codes

The laboratory uses the GMC and NMC numbers as the unique sample taker identifier. This information MUST be provided. The sample taker name should also be printed clearly. When electronic requesting has been introduced, the GMC or NMC code will be a mandatory field. The laboratory will check that the sample taker is validated to take samples i.e. is up-to-date with their training requirements.


The label on the sample vial must record the forename (or initial), surname and date of birth, and the NHS number (if known) to allow matching of the vial with the request form. After collection and labelling, the sample should be placed into the sealable sections of the plastic specimen bag with the request form attached, before dispatch to the laboratory.


(Last updated January 11th 2017)