Requisition slips

All rights to the listed requisition slips are the exclusive property of Labor Berlin. Embedding on third-party homepages or otherwise making available for download in third-party offers is expressly prohibited without a separate written agreement with Labor Berlin.
Note for private individuals / private direct senders of samples without a medical referral form
We can only analyze and test sample material sent to us if we have a laboratory order from the doctor treating you (referral form for laboratory tests, sample 10 for those with statutory insurance / private referral form for those with private insurance).
Direct submissions from private individuals on a self-payer basis without a medical referral form must be coordinated with us in advance via mein-labor@laborberlin.com (see also Mein-Labor.Berlin). You will then receive a list of the estimated costs and a private medical treatment contract. We expressly reserve the right to refuse laboratory analyses if they are so specific that they should only be requested by a treating physician – also in order to ensure a medically meaningful diagnosis and a holistic interpretation of the laboratory findings.
We ask for your understanding that we will not process submissions from private individuals that have not been agreed with us in advance and that are made without a medical referral form.
Note for submitting institutions
Please note:
Services for private patients, self-paying patients or elective laboratory services will be invoiced by LABOR BERLIN directly to the respective payer, unless otherwise agreed with the sender.
For this purpose, the sender shall forward the necessary patient data to LABOR BERLIN and ensure that the patients are informed about the possible forwarding of laboratory orders to LABOR BERLIN and the associated organizational measures, including billing by a private medical clearing office, in the manner prescribed by law and consent to this.
The legal requirements with regard to the free choice of doctor are taken into account. We would like to point out that, in accordance with the provisions of the German Hospital Remuneration Act (KHEntgG), external elective laboratory services must be ordered by the sender on a case-by-case basis and specifically by the elective physicians concerned.
-
-
Instructions: The new Channel 4 with diagnostic information
pdf -
Instructions: The new design – CHANNEL Vivantes/ Charité
pdf -
Request deactivation of fax transmission
pdf -
Application for additional claims
pdf -
Declaration of consent for material transfer
pdf -
Notification of patient mix-up / sample mix-up
pdf -
Declaration of consent for the performance of genetic tests
pdf
-
-
-
Requisition slip for allergy diagnostics
pdf
-
-
-
Requisition slip for autoimmune diagnostics
pdf
-
-
-
Requisition Slip Hämatologie Zytologie (Standort CVK)
pdf -
Hematology requisition slip (CCM location)
pdf -
Declaration of consent for tumor cytogenetics and tumor genetics
pdf -
Requisition slip for hematology combination certificate Cytology & Molecular Genetics (CVK site)
pdf -
DPD diagnostics requisition slip
pdf
-
-
-
Lynch syndrome request form
pdf -
Requisition slip for liver and pancreas
pdf -
Requisition slips for muscular & neuromuscular diseases
pdf -
Requisition slips for hearing impairment/deafness
pdf -
Preanalytics Molecular genetics
pdf -
Preanalytics tumor cytogenetics
pdf -
Requisition slip for prenatal cytogenetics
pdf -
Requisition slip for postnatal cytogenetics
pdf -
Requisition slip for tumor cytogenetics
pdf -
Requisition slip for cytogenetics from abortion material
pdf -
Requisition slip for connective tissue diseases
pdf -
CFTR requisition slip
pdf -
Requisition slip for endocrinological diseases
pdf -
Requisition slip for lipid metabolism disorder
pdf -
Requisition slip for cardiological diseases
pdf -
Requisition slip for bone and skeletal diseases
pdf -
Requisition slip for congenital myasthenic syndromes
pdf -
Requisition slip for lymphoedema
pdf -
Nephrogenetics requisition slip
pdf -
Noonan syndrome requisition slip
pdf -
Requisition slip for pulmonary hypertension
pdf -
Requisition slip Rett-like and Angelman syndrome
pdf -
Requisition slip for platelet disorders
pdf -
Requisition slip for primary immunodeficiencies
pdf -
Requisition slip for lung diseases
pdf -
Patient information on incidental findings in WES
pdf
-
-
-
Accompanying certificate for connatal CMV diagnostics from dried blood (newborn screening card)
pdf -
Virology requisition slip
pdf -
Requisition slip virology hantaviruses (consulting laboratory)
pdf -
Requisition slip virology novel coronaviruses (SARS-CoV-2)
Please use this request form as a color printout, as this is relevant for machine reading.
pdf
-