Test Requisitions and Customs Declarations Forms for Physicians
Ordering Tests | Customs Forms
The Diagnostic Center for Heritable Immunodeficiencies at Cincinnati Children's Hospital Medical Center performs a variety of molecular diagnostic and carrier tests for inherited immunodeficiencies and familial hemophagocytic lymphohistiocytosis. Doctors need not be affiliated with Cincinnati Children's to order tests.
Physicians Ordering Tests
When ordering tests, physicians must complete and sign the test requisition and enclose it with the sample. All information must be completed before the sample can be processed.
You can download the following test requisition in portable document format (.pdf):
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Customs Forms
Physicians from outside the United States who are requesting tests must complete a customs declarations form to accompany their samples. You can view a sample of how to complete the customs declarations form. (1.4 MB)
You must have Adobe Acrobat" Reader installed on your computer
to read the .pdf files.
You can download Adobe Acrobat" Reader at Adobe's Web site by
selecting the version appropriate for your type of computer.
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For more information about the Diagnostic Center for Heritable Immunodeficiencies, please call 513-636-4474 or send an email to moleculargenetics@cchmc.org.
