Create an HMR101 sample request form

From the Patient Summary screen, select Go to HMR101.

Next, enter your sample taker code. CSMS does not validate sample taker codes. However, this information is required on the HMR101 form when sending it with a sample to a laboratory. The code entered into CSMS will appear on the HMR101 form.

There are 2 options for creating a HMR101 sample request form: 

This option will pre-populate the form with the participant's demographic details, and all entered sample and clinical details. This reduces the risk of the lab receiving incomplete or illegible information and the sample potentially being rejected on that basis.

This option will pre-populate with the participant's personal and demographic information only. The sample and clinical details will then need to be completed on the printed form by hand.

At any point whilst entering details to be pre-populated on the HMR101, there is an option to go back to the previous screen to re-enter or check the details entered.

The patient may receive their result via the NHS App. Please remind them to switch on notifications.

If they do not have the NHS App or do not open the message, they will receive a letter in the post.

Should a letter need to be sent, and the patient wants to receive it at an alternative address, you can add this to the HMR101 form on the next screen. This address will only be used for this test result and will not update the patient’s registered address.

You will be asked to fill in the following details:

• 1st day of last menstrual period
• additional information - select all options that apply to the participant. Multiple options can be selected

Select Continue to move to the next screen.

You will be asked to fill in the following details:

• test date - this will be pre-populated with the date that day
• source of the sample - select the appropriate location for where the sample is being taken
• reason for sample - select the reason the sample is being taken at that time
• sample type - if the sample is other than a cervical sample, explanatory details can be entered in the free text box

Select Continue to move to the next screen.

All relevant clinical information should be entered into the free text field provided. This may include information of any signs or symptoms reported by the participant and any history of abnormalities and treatment. There is a limit of 500 characters in the free text box.

Select Continue to move to the next screen and preview the pre-populated HMR101 form.

Once the preview of the populated HMR101 form has been reviewed, select Print HMR101 form.

The HMR101 form prints in landscape and A4. Make sure the printer is set correctly when printing.

The system will not print any labels for sample containers. It will only print the HMR101 form.