We require the physician to order any special needs initially. Once they are identified, we can place a patient instruction in our blood bank system for fiurther orders. We do require that the patient be tested for CMV status and will remove the CMV neg request if they are CMVpositive. If we get special needs requests that don't really seem to make sense then we can take this to our medical director and have her speak to the ordering physician. Most of our requests for Irradiated and/or CMV neg come from our Heme/Oncology docs.