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OF/TEC/008 PHYLOGENETIC REQUEST FORM Unis tel Medical Laboratories (Pty) Ltd US Faculty of Health Sciences, Clinical Building, Room 2128, Gerber, 7505, RSA Tel:+27 21 9389213 Web: www.unistelmedical.co.za

How to fill out the specimen request form

How to fill out the specimen request form:

1. Fill in the patient's information: Provide the patient's full name, date of birth, gender, and any other requested personal information. It is important to accurately enter this information to ensure proper identification and processing of the specimen.
2. Indicate the type of specimen: Specify the type of specimen being requested, such as blood, urine, tissue, or other. Be as specific as possible to ensure the correct analysis or testing is conducted.
3. Provide necessary medical information: Include relevant medical history, symptoms, and any specific instructions or details requested on the form. This information helps healthcare professionals tailor the analysis or testing to the patient's individual needs.
4. Include ordering physician information: Enter the name, contact information, and any specific instructions from the ordering physician. This is crucial for proper communication and coordination between healthcare providers.
5. Include insurance information: If applicable, supply the patient's insurance details, including the policy number and any relevant authorizations. This ensures that the requested testing or analysis is covered and processed correctly by the insurance provider.
6. Payment information: If payment is required for the specimen analysis or testing, provide the necessary payment details as requested on the form. This may include insurance co-payments, deductibles, or other payment arrangements.

Who needs the specimen request form?

1. Healthcare providers: Doctors, nurses, or other healthcare professionals who need to request specific laboratory tests or analyses for their patients. The specimen request form serves as a formal request to the laboratory or diagnostic facility.
2. Laboratories and diagnostic facilities: These facilities require a specimen request form to properly process and analyze the patient's sample. It provides them with the necessary patient and testing information to conduct the requested analysis accurately.
3. Patients: The specimen request form serves as a way for patients to communicate their testing needs with their healthcare provider. By filling out the form, patients ensure that the necessary tests are conducted and their specific medical concerns are addressed.

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