SPECIMEN KIT & FORMS
To request kits: Complete the PDF or Electronic Immunodermatology Kit Order Form and submit PDF via FAX or through the the Electronic Form. Your specimen kit(s) with prepaid Fed-Ex return & labels will be sent to you promptly.
Watch the video below for a step-by-step guide for submitting your specimen for testing. To request testing: Complete the Test Requisition Form PDF.
SPECIMEN KIT CONTENTS
Once you receive the Specimen Kit you will have what you need to send a specimen for testing. Here is what the kit contains.
One tube with Michel's transport medium (bright green) for skin biopsies (one specimen per tube) for direct immunofluorescence
One tube of formalin for fixed tissue histological examination
One small empty cryovial for serum
Labels for vials
Immunodermatology Request Form
Information & instruction sheets
Take the time to review our biopsy instructions and specimen transport information
KIT TRANSPORT INFORMATION
Complete the Immunodermatology Request Form. The following patient data are needed for interpretation:
Patient's full name
Birthdate (if patient is underage, guarantor name and birthdate are also needed)
Clinical diagnosis and brief history
Exposure of site to sun (sun exposed, non-sun exposed)
Relationship to lesional skin (perilesional, involved, uninvolved)
Procurement date of all specimens submitted
Complimentary courier services are available within carrier range, and can be arranged by contacting the laboratories for scheduling. Where courier service is not available, specimens can be shipped via expedited shipping.
Mail the specimen(s) in the return mailer at ambient temperature.
If mailer and transport medium are not available, ship the tissue specimen frozen on dry ice by express mail, packing in enough dry ice to stay frozen until receipt in laboratory. Do NOT mail vials filled with transport medium or formalin on dry ice. Serum should be shipped at ambient temperature.
The specimen kit mailer has a return label. If a mailer is not used, the shipping address is:
417 South Wakara Way, Suite 2151
Salt Lake City, UT 84108
The University of Utah Department of Dermatology is contracted with all major health insurance plans. Our Billing Office will bill patient’s insurance for laboratory processing and testing. Other billing arrangements are available. For questions regarding specific client billing arrangements, please contact us via email at DermatologyLaboratories@hsc.utah.edu.
Patients are responsible for all medical charges associated with the laboratory services provided at our facility. To verify specific coverage, patients should contact their insurance provider. Insurance participation is subject to change over time.
Should patients have questions about a University of Utah Department of Dermatology billing statement, please inform them to contact the Dermatology Billing Office toll-free at 1-800-245-0357.
Self-Pay Patient Discount
We offer discounts and payment plans to self-pay patients:
A 30% discount will be applied to the patient's bill if paid in full within 30 days.
Monthly payment plans can be arranged with a minimum payment of 10% of the total balance.