Forms

• Customer Feedback Form

• View the form here.

• Usage & Definitions

• Training
• Enrolling Staff
• Training Test

• Versiti Michigan 4-Character Product Code Key
• Product Code Description Key
• Product Listing by ISBT Code

• Versiti Michigan Most Likely Import Centers

• Component Return Credit
• Component Transfer Form
• Component Credit Form
• Hospital Packing Instructions

• Adverse Recipient Event (ARE) - Infectious Agent
• Non-Viral Adverse Recipient Event (ARE) Report

• Aberrant or Discrepant Result Investigations
• Antibodies to High and Low-incidence Antigens
• Auto-Antibodies
• Drug-Dependent Antibodies
• Hemolytic Disease of the Newborn Investigations
• Reagent-Dependent Reactivity
• Single to Complex Multiple Antibodies
• Transfusion Reaction Investigations

• ABO Discrepancies
• Discrepant Red Cell Antigen Typing
• Donor/Patient Red Cell Phenotype and Genotype (Serologic and Molecular testing available)
• Polyagglutination Investigation
• Prenatal Evaluations (ABO/Rh, ABID, titer)
• Weak Antigen Expression Investigations

• Consultation Request Form
• Reference Lab Email Encryption for Final Result
• Reference Lab Tag
• Updated Charge Process

Submitting Samples

To submit a sample for investigation, follow the flowchart or the steps listed below.

1. Draw the sample (view sample requirements)
2. Complete the Indiana Consultation Request Form (updated 09/04/19)
3. Call the Reference Lab at 317-916-5188, option 1, to request a courier to pick up the sample
    

Requesting Rare Units

To request rare antigen negative blood, follow the flowchart, complete the Indiana rare unit request form, or the steps listed below.

1. Call the Reference Lab at 317-916-5188, option 1
2. Speak with the Reference Lab Specialist to arrange for delivery of rare units