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Welcome, and thank you for your interest!. The physicians and staff at Peterson Laboratory Services. PLS Pathology. Quality Assurance Standards And Procedures for Specimen Submission. Tools. PLS Reference Manual Hard copy Online at Provided Sample Requisition

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The physicians and staff at Peterson Laboratory Services

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Welcome, and thank you for your interest!

The physicians and staff at Peterson Laboratory Services

pls pathology

PLS Pathology

Quality Assurance Standards


Procedures for Specimen Submission



  • PLS Reference Manual
  • Hard copy
  • Online
  • Provided Sample Requisition
  • This online training module
  • CD by request
  • PLS: 1- 800-876-5522


  • Requisition
  • Specimen Preparation
  • Review


  • Correct requisition
  • Patient name
  • Date of birth
  • Date and time of collection
  • Physician first and last name
  • “Additional copy to”
  • Clinical history
  • Specimen source
  • Diagnosis and/or “signs and symptoms”
  • Signature
  • Other
correct form

Correct Form

  • Three PLS Requisition forms:
  • Cytology
  • Non-genital Cytology
  • Surgical/Biopsy –Form 300 (pink)
patient name identifier

Patient Name/Identifier

  • Stamp, attach patient label, or hand write – first and last names
  • Consistent name for each patient (ex: alternately using middle name on some orders – first or initials on others)
  • Recent name change? An attached note is helpful
  • Submit patient identifying SS or other number (not financial guarantor SS or other number)
date of birth

Date of Birth

  • Accurate
  • Legible
  • Birthdate, not today’s date
  • Patient birthdate, not guarantor’s birthdate
date time of collection

Date/Time of Collection

Important information for diagnosis!

  • Surgery Date
  • Time of collection
ordering physician

Ordering Physician

  • Many area physicians share same/similar last name
  • Give full first and last name, please
copy to

“Copy To:”

  • Place in the “copy to” box
  • Faxed? Please provide fax number
  • Mailed? Please provide location or mailing address
patient history

Patient History

  • Patient history is important to the diagnosis
  • Please include information
  • If more space is needed, feel free to write in the “Frozen Section” space directly below
specimen source

Specimen Source

  • Record in box “Anatomic Origin of Specimen”
  • Write info on line after “container #x __________”
  • Include correct site & side of body
  • Example: “lesion, RT lower leg”


  • Record diagnosis code, or
  • “Signs and Symptoms”
  • Example for a submitted nevi: “growing, irregular borders”
  • Check “INPT” or “OUTPT”


  • Please provide your signature
  • Used for follow-up questoins if necessary
other considerations

Other Considerations

  • Please do not mark in “For Office Use Only” Box
  • Please initial any mark outs or changes
  • Please include copy of insurance card/s and or face sheet


  • Packaging
  • Labeling
  • Transport


  • Placed in appropriately sized, approved container
  • Ratio of formalin/specimen of 10:1
  • Container placed in secondary container (specimen bag)
  • Requisition accompanying each specimen, unsoiled
  • Example: Specimen in biopsy bottle - biopsy bag in orange striped specimen bag - requisition in outside pocket of specimen bag
what goes in what
What Goes In What?
  • Tissue Biopsy Formalin
  • Excision Formalin
  • Fine Needle (core) Biopsy Formalin
  • Washings/Fluid Fluid Itself Alcohol if very small
  • Wang Needle Aspirates Alcohol
  • Fine Needle Aspirates Alcohol or Saccamono
  • Smears Spray fix immediately

if head/neck/lymph 2 air-dried slides also

packaging cont


  • Supplies provided by PLS
  • 20,40, 60 ml 10% formalin containers
  • 5 L formalin container
  • Small, medium, large biopsy bags
  • Requisitions
packaging cont1


  • Large specimens:
  • Slow penetration of formalin
  • Refrigerate after fixative added
  • Very large specimens (i.e., limbs): place in two large red biohazard bags - label with patient name, hospital and source


  • Specimen Container Label:
  • Pt first and last name
  • Specimen source (site and side of body)
  • Physician name
  • Date collected
common errors

Common Errors:

  • Specimen & requisition have different names
  • Writing # on container, instead of content
  • No label on specimen
  • Requisition but no specimen
  • Submitted in specimen bag, instead of biopsy bag
  • Specimen submitted without fixative
  • Wrong fixative/wrong kit on special study testing. Call Client Services if questions


  • Place in hospital/clinic location for PLS pickup
  • Pickup times vary by location & arrangement
  • Patient care depends upon specimen quality – place specimens for pickup as soon as possible
transport cont

Transport Cont..

  • If Delivered Personally:
  • Take directly to the gross room of the histology dept
quality variance report

Quality Variance Report

  • If error, Quality Variance Report is sent
  • Please note corrective action taken, sign and return
  • CLIA monitors reports and action is taken


  • Which form is used to order pathology testing?
  • Form 101A
  • Form 15
  • Form 300
  • Patient test results may be sent to other providers upon request of ordering physician
  • True
  • False
  • Signs and symptoms pt experiencing is sufficient under “Diagnosis Code.”
  • True
  • False
review cont

Review, cont…

  • The ratio of formalin to specimen is:
  • 7:1
  • 9:1
  • 10:1
  • Content, or container number, is required for specimen labeling.
  • Content
  • Container Number
  • Refrigerate large specimens until courier pickup.
  • True
  • False


We are always standing by to assist you

thank you for participating

Thank you for participating…

We appreciate your business!