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NH PUBLIC HEALTH LABORATORIES DEPARTMENT OF HEALTH AND HUMAN SERVICES 29 Haven Drive, Concord, NH 03301 Telephone: 603-271-4661, Fax: 603-271-2138 LABORATORY TEST REQUISITION INFLUENZA Requisition
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How to fill out influenza test requisition
How to fill out influenza test requisition:
01
Start by obtaining a copy of the influenza test requisition form from your healthcare provider or testing facility.
02
Carefully read and fill out the patient information section of the form, including your full name, date of birth, address, and contact information.
03
Provide your insurance information, including your policy number and any necessary authorization codes.
04
Indicate whether you have any known allergies or medical conditions that are relevant to the test.
05
Specify the reason for the influenza test, such as experiencing flu-like symptoms or being in contact with someone diagnosed with the flu.
06
If required, select the preferred type of test or indicate any specific instructions or requirements requested by your healthcare provider.
07
Review the form to ensure all sections are completed accurately and legibly.
08
Sign and date the requisition form at the designated area.
09
Return the completed form to your healthcare provider or testing facility as instructed.
10
Keep a copy of the filled-out requisition form for your records.
Who needs influenza test requisition:
01
Individuals who are experiencing flu-like symptoms, such as fever, cough, sore throat, runny or stuffy nose, body aches, fatigue, or headaches.
02
People who have been in close contact with someone diagnosed with influenza.
03
Individuals who require an influenza test for occupational or travel-related purposes, as determined by their employer or relevant authorities.
04
Patients undergoing pre-operative screening or hospital admissions may be required to provide an influenza test requisition.
It is important to consult with your healthcare provider to determine if an influenza test requisition is necessary for your specific situation.
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What is influenza test requisition?
The influenza test requisition is a document used to request testing for the presence of influenza virus in a patient's sample.
Who is required to file influenza test requisition?
Healthcare providers and medical facilities are required to file the influenza test requisition when requesting influenza testing for their patients.
How to fill out influenza test requisition?
To fill out the influenza test requisition, you need to provide the patient's information, such as name, date of birth, and contact details. Additionally, you may need to indicate the reason for the test and the type of sample being submitted for testing.
What is the purpose of influenza test requisition?
The purpose of the influenza test requisition is to facilitate the request for influenza testing and ensure that the necessary information is provided for processing and reporting the test results.
What information must be reported on influenza test requisition?
The influenza test requisition typically requires information such as patient's demographic details, reason for the test, sample type, and relevant medical history.
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