PFAS patient registration
Register one patient at a time for the PFAS serum panel with additional EEA analysis. Use the sample code on both collection tubes.
Manual PFAS request form
Print one form for each patient. Keep the completed form in the separate document compartment of the sample bag. To receive a PFASTMS sample code, register the patient online first.
PFAS serum request
Thomas Medical ServicesEEA-NH4 CAS 908020-52-0 · Corresponding EEA acid CAS 80153-82-8
Specimen: separated serum · Research and informational use
| Patient full name | |
|---|---|
| Date of birth (DD-MM-YYYY) | |
| Sex | |
| Patient email | |
| Telephone | |
| Address | |
| Postcode / city | |
| Country | |
| TMS patient reference | |
| Registered by | |
| Collection date | |
| Collector | |
| Clinic / batch reference | |
| Collection time | |
| Serum separation time | |
| Storage / dispatch details | |
| Notes for WHL |
☐ Patient / authorised representative permission obtained; patient details checked; research and informational purpose explained.
Staff signature: __________________________ Date: __________________
Tube label / sample reference: __________________________________________
Label both tubes: Use the patient’s full name, date of birth and your TMS sample reference. PFASTMS codes are issued only through online registration.. Use WHL-approved materials, separate serum and follow the WHL collection instructions. Do not freeze unseparated whole blood. Keep this form in the separate document compartment.
This service is provided for research and informational purposes. It is not offered for diagnostic or forensic use.