Request an Anatomic Pathology Consultation

To request an Anatomic Pathology Consultation, please complete the Anatomic Pathology Consult Requisition form in its entirety.

This form MUST BE SIGNED by the ordering provider and MUST INCLUDE the following:

  • First and last name of ordering provider
  • Complete name of the office/facility including address, phone number, and fax number
  • Billing directives: will the provider’s office receive the bill or will the patient’s insurance company
    • If the patient’s insurance company is to be billed, include updated demographic information as well as the contact information for the insurance company
  • Indicate "Specimen Forwarded" and "Services Requested".
  • For a list of special and immunohistochemical stains, in-situ hybridization and immunofluorescence options, refer to our stain menu. Our menu is frequently updated. If you have another request, please call Client Services at (800) 934-6575 for availability.

Questions? Contact the Nationwide Children's Hospital Anatomic Pathology Department at (614) 722-5450.

For information on our solid tumor and hematologic cancer fusion analyses (ARCHER panels), please visit our Laboratory Guide to Services for shipping instructions and request form.

Pathology Consultation Form
Download the Anatomic Pathology Consult Requisition Form
Stains Menu
Download the Immunohistochemical/Special Stains Menu