Requisition Forms

Laboratory Test Requisition Forms

Please label each specimen tube carefully with the patient's last name, first name and date of birth and complete the respective laboratory test requesition form.

The requesition forms are designed to provide us with all necessary patient information including the patient´s informed consent.

Please fill in the forms carefully. Please note that unlabelled or incorrectly labelled tubes cannot be accepted.

Genetic testing is not possible without the patient´s consent.

1. Patient information sheet (english) (german)

Informed consent for genetic testing (english) (german)

Billing consent form (unimed) (english) (german)

2. Requisition forms and patient consent form (where required) (pdf)

Requisition form: Molecular genetics (english) (german)
Requisition form: Cytogenetics and (FISH) Diagnostics
Requisition form: Leukemias and Lymphoproliferative Diseases
Requisition form: Molecular Leukemia Diagnostics
Requisition form: MRD Diagnostics

For internal use only:

Requisition form: Fetal pathological-humangenetic examination
Requisition form: Consultation service

Please send samples to the following address:

Heidelberg University Hospital
Institute of Human Genetics

Followed by the respective laboratory, i.e.:

Laboratory for Molecular Genetic Diagnostics/
Laboratory for Molecular Cytogenetic Diagnostics/
Laboratory for Cytogenetic Diagnostics/ or
Laboratory for MRD Diagnostics

Im Neuenheimer Feld 366
69120 Heidelberg

 

For further information please refer to our list of services

General information:

  • Further details on the required sample material can be taken from our list of services under the respective headings.
  • For a molecular genetic analysis please use EDTA tubes.
  • For cytogenetic testing, please use Na or NH4 heparin tubes (do not use: Li-heparin tubes or EDTA tubes!).
  • No fasting required before blood draw.
  • After blood collection, invert the tube gently to mix the anticoagulant with the blood and to avoid partial clotting.
  • When collecting amniotic fluid, please discard the first 1-2 ml.
  • When collecting blood after a bone marrow transplant or blood transfusion, please consult with our Clinical laboratory professionals.
  • Sample material must be collected, disposed of separately and labelled as "potentially infectious".
EN