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Requesting a cervical screening test

Electronic requesting

Electronic requesting for cervical screening tests is available to all GP practices via a system called ICE. This will eliminate the need to complete paper copy request forms and ensure all mandatory information is provided. If ICE is unavailable at any point, sample takers will have the option to complete a paper request form or download and print a form directly from Open Exeter.

Open Exeter request form

The electronic HMR101 request form can be downloaded from Open Exeter for those sample takers who have been trained in the use of this form. Training guidance can be provided by contacting PCSS (Preston). 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.

The version to use is HMR101 form A5 PDF (2009). This document will be pre-populated with the forename, surname, date of birth and NHS number, as well as the date of the previous test. Also printed on the form is the cervical cytology history for the woman.

If you require any support in accessing the request form on Open Exeter, please contact LASCA:

Head of Contractor and Patient Services
Elaine Jones 01772 221 340

Screening Development Manager
Pauline Fisher 01772 221 345

HMR101 form A5 PDF (2009)

HMR101 form

Printing the HMR101 form - if possible please print in 'portrait format' to facilitate use in the laboratory.

Don't forget to print your name and your GMC or NMC code.


(Last updated March 30th 2016)