RCI test request form

 Please use our test request form (FRM1597/4.2) to request the investigation of:

• Allo and autoantibodies
• Autoimmune haemolytic anaemia
• Haemolytic disease of the fetus and newborn (HDFN)
• Haemolytic transfusion reactions
• IgA deficiency

Please refer to INF417/1.1 - for instructions on how to complete the test request form.  

When requesting a test and sending samples,  please ensure you fax confirmation (FRM3775/3).

For our requirements for completing the form and labelling samples, please see MPD637 in Clinical Guidelines

Please contact your RCI laboratory if you need supplies of the form. This form has been designed based on user feedback.