[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-276226-105":53,"doc-detail-276226-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","pathology-consultation-specimen-transmittal-form-request-submission-details","Pathology Consultation-Specimen Transmittal Form - Request submission details","","Pathology Consultation-Specimen Transmittal Form is used to facilitate diagnostic consultation and registry enrollment by collecting referring physician and institution details. The form captures patient information and diagnosis dates, then requires submission checklist items such as complete pathology reports, H&E slides, unstained sections for immunoperoxidase (or equivalent blocks), and sterile paraffin scrolls stored in individual Eppendorf tubes. It also records accession number, slide/block/scroll counts, whether frozen tissue is available, and shipping return requirements, including U.S. and international shipping labeling instructions.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/pathology-consultation-specimen-transmittal-form-request-submission-details/276226/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/pathology-consultation-specimen-transmittal-form-request-submission-details/276226.png","ImageObject",442,249,{"name":88,"@type":89},"Ben Jamin","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-11-03","2026-09-15",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",10,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information is required from the referring physician and institution?","Question",{"text":109,"@type":110},"The form collects referring pathologist and referring institution details, including contact information and address fields.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"What specimen materials must be included with the submission?",{"text":114,"@type":110},"It requires complete pathology report(s), 2 H&E slides from the most representative block, additional unstained sections for immunoperoxidase, and four 10-micron paraffin scrolls in sterile Eppendorf tubes.",{"name":116,"@type":107,"acceptedAnswer":117},"How should frozen tissue availability and shipping be handled?",{"text":118,"@type":110},"The form asks whether frozen tissue is available; if it is, the registry contacts the submitter separately about shipping. It also specifies FedEx shipping details and required international labeling.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},276226,1791106786,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":4},2336478466772,"https://ap-avatar.wpscdn.com/davatar_3d24733baf745e90a7e4bdd5f77d97b2","Pathology Consultation-Specimen Transmittal form  \nDiagnostic consultation or Registry enrollment  \nPhysician Information  \nReferring Pathologist:  E-mail:   Phone:   Fax:   Referring Institution:    \nAddress/City/State/Zip/Country_____________________________________________________________________________  \n______________________________________________________________________________________________________  \nReferring Oncologist:   E-mail:   Phone:  Fax:   Patient Information (please use one form for each surgical case)  \nPatient Name (last, first):   Date ofBirth (mm/dd/yyyy):   Diagnosis Date (mm/dd/yyyy): Diagnosis  Patient’s Clinical History/Surgical History:    \nInclude the following with your submission:  \n􀂃 Complete pathology report(s) AND  \no 2 H&E slides from the most representative block  \no 10 unstained sections (on plus charged, polarized slides) for immunoperoxidase or 1 block  \no Four, 10-micron paraffin scrolls from representative block in sterile Eppendorftubes.  \nPlease place each scroll in its own sterile Eppendorf tube.  \nIf frozen tissue is available, we will contact you separately regarding shipping.  \nIs FROZEN TISSUE available? Yes No  \nAccession \\#:   Diagnosis date (mm/dd/yyyy):    \nTotal \\#slides:   Slide numbers:    \nTotal \\# blocks:   Block numbers:    \nTotal \\# scrolls:   Other materials:    \nDo pathology materials need to be returned? All   \nNone   \nBlocks only  Date materials sent to the Registry:   \n\n| SHIPPING INFORMATION\u003Cbr>Ship via FedEx* using account \\# 659273071,\u003Cbr>reference \\# 20435 30024\u003Cbr>Children's Minnesota\u003Cbr>International PPB/DICER1/OTST Registry\u003Cbr>2545 Chicago Ave\u003Cbr>Suite 515\u003Cbr>Minneapolis, MN 55404 USA | FOR INTERNATIONAL SHIPPING\u003Cbr>Label outside of the package with the following: “The package contains preserved, non-infectious human tissue on glass slides orin paraffin wax for medical diagnosis purposes.” |\n| --- | --- |\n\n2545 Chicago Ave., Suite 515, Minneapolis, MN 55404  \nP: 612-183-7121 F: 612-813-7108","cbCaitJvIbl3wuHT","https://ap.wps.com/l/cbCaitJvIbl3wuHT","pdf",324190,"English","# Physician Information\n## Patient Information\n# Submission Materials\n## Frozen Tissue Availability\n# Accession and Specimen Tracking\n# Shipping Information","[{\"question\":\"What information is required from the referring physician and institution?\",\"answer\":\"The form collects referring pathologist and referring institution details, including contact information and address fields.\"},{\"question\":\"What specimen materials must be included with the submission?\",\"answer\":\"It requires complete pathology report(s), 2 H\\u0026E slides from the most representative block, additional unstained sections for immunoperoxidase, and four 10-micron paraffin scrolls in sterile Eppendorf tubes.\"},{\"question\":\"How should frozen tissue availability and shipping be handled?\",\"answer\":\"The form asks whether frozen tissue is available; if it is, the registry contacts the submitter separately about shipping. It also specifies FedEx shipping details and required international labeling.\"}]","Pathology Consultation-Specimen Transmittal Form - Request submission details | PDF",1789492023]