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 the primary care collection points and the centralised laboratory.

Electronic requesting

The laboratory is actively encouraging the use of electronic request forms. Please contact the Laboratory IT support team to set up electronic requesting in your practice/clinic.

Open Exeter request form

Until you are set up for electronic requesting, the Open Exeter HMR101 form can be downloaded from the Exeter system. Please complete the form, paying particular attention to the provision of relevant clinical history. Also print your full name and your NMC, GMC or PA number

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

Tel: PCSE Customer Support Centre on 0333 014 2884

Email: Preston office: pcse.screening-preston@nhs.net

 

Paper request forms

These are being actively phased out by the laboratory and should only be used when electronic requesting is not available due to an IT issue. In this case the paper request form should be completed in full with all information PRINTED legibly or a printed label containing patient demographics can be used.

Whichever request form is used, 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.

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 samples.

 

(Last reviewed July 2019)