Skip to Main Content
CWRU Links

School of
Medicine

Pathology

Forms

Forms

Test Reporting

All specimens sent to the Center must accompany a completed Test Request Form. For autopsy cases, the Autopsy Consent and Testing and Reporting Policies Forms must be completed and submitted to the Center along with clinical history/medical records of the patient. Delays in reporting may result without this information.

The forms avaiable on this page are in Adobe PDF format. You may download the free Adobe Acrobat Reader to view these files by clicking on the link below. If you have any questions, please contact us at 216-368-0587 or by email at cjdsurveillance@uhhospitals.org.

Autopsy Consent Form

Please complete the Autopsy Consent Form (PDF) if you would like us to coordinate an autopsy.

Test Request Form

The Test Request Form (PDF) must be completed for all samples submitted to the Center. The Center is fully compliant with HIPAA regulations.

Testing and Reporting / Gentetics Consent Form

The Testing and Reporting Genetics Consent Form (PDF) must be completed whenever blood or frozen brain tissue is sent to our Center in order to release genetic results.

Cerebrospinal Fluid and Biopsy Billing Requisition Form

The CSF and Biopsy Billing Form (PDF) must be completed ONLY when sending cerebrospinal fluid or biopsy tissue to our Center for testing and we are to bill patient directly.