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Special Stains
Requisition Form
Ordering Physician:
Email Address:
Date Requested:
Accession#:
Block#:
AFB
Alcian Blue PAS
Colloidal Iron
Congo Red
Elastic
Giemsa
GMS
Gram
Iron
Iron Smear
Mucin
PAS
PAS Diastase
PAS/Fungus
Retic
Trichrome
Comment:
Send
Dermatopathology IHC / Special Stains
Requisition Form
Ordering Physician:
Email Address:
Date Requested:
Accession#:
Block#:
AFB
Cam 5.2
CD10
CD34
CD68
CK20
CK5/6
Colloidal Iron
Elastic
EMA
Factor 13a
Giemsa
GMS
HMB45
Ki67
Mart-1
MLH1
MSH2
MSH6
Mucin
P16
P63
Pan-cytokeratin
PAS diastase
PAS/F
PHH3
PMS2
S100
SMA
SOX10
Trichrome
Deeper X
select#
1
2
3
4
5
6
7
8
9
10
Recut X
select#
1
2
3
4
5
6
7
8
9
10
Comment:
Send
