RCI test request form

Form 1A 

Please use our test request form (PDF 420KB) to request the investigation of:

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

Fax confirmation is needed

When requesting a test and sending samples, please ensure you fax (Word 49KB) for confirmation.

Requirements for completing Form 1A and labelling samples

 Please read the sample labelling policy in Clinical Guidelines for our requirements.

Ordering the form

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