RCI test request form

Form 1A 

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.  

Fax confirmation is needed

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

Requirements for completing Form 1A and labelling samples

For our requirements, please see MPD637 in Clinical Guidelines

Ordering the form

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