Request forms

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The national HPV primary screening implementation guide recommends the universal implementation of GP electronic test requesting as an opportunity to improve the transportation of samples and improve the tracking of samples between primary care collection points and the centralised laboratory.

Electronic requesting

We recommend that you use electronic cervical screening sample requesting. All registered sample takers can request using the web-based ICE Desktop application to complete a cervical screening request. Should ICE Desktop be unavailable for any reason, please download the HMR101 cervical screening test request form (2009 version) available via Open Exeter. This version is pre-populated with the woman’s forename, surname, date of birth, NHS number, date of previous test and cervical screening history. Remember to print your full name and GMC or NMC number on the Open Exeter form.

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

PCSE Customer Support Centre on 0333 014 2884

Please contact the Laboratory IT support team to set up electronic requesting in your Practice/Clinic

The provision of information relating to previous 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.

Paper request forms

These are being actively phased out by the laboratory and should only be used when there is electronic requesting/printer failure due to an IT issue and the Open Exeter request form is also unavailable or a patient is not registered on the Exeter system. In the rare event of IT failure, we have provided the cervical screening request form template which can be used to provide a minimum number of pre-printed paper copies for use in emergencies only.

The paper request form must be completed in full with information PRINTED legibly or a printed label containing patient demographics can be used.

NHS number

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

PIN codes

The GMC, NMC or Physician Associate (PA) number is the unique sample taker identifier or PIN code. This information MUST be provided on all request forms. The sample taker name should also be printed clearly. If a PIN code is not given, is illegible or the sample taker is not registered on the CSTD, this is reportable to the Screening & Immunisation Team so that enquiries can be made to determine if the sample taker is validated to take cervical screening samples.


(Last reviewed April 2021)