Histopathology Forms

Sample cover letter requesting clinical information with request for pathology consultation.

Form A - Liver Consultation Clinical Information Form
Form B - Protocol Evaluation of Liver Biopsies
Form C - Gastrointestinal Biopsy Clinical Information
Form D - Protocol Evaluation of Gut Biopsies
Form E - Cutaneous Consultation Clinical Information Form
Form F - Protocol Evaluation of Cutaneous Biopsies
Form G - Oral Mucosa Consultation Clinical Information Form
Form H - Protocol Evaluation of Mucosal Biopsies 

For background information about use of the histopathology forms, see Shulman HM, Kleiner D, Lee SJ et al. Histopathologic Diagnosis of Chronic Graft-versus-Host Disease: National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: II. Pathology Working Group Report, Biol Blood Marrow Transplant. 2006 Jan;12(1):31-47.