Get the free laboratory test request form

This document serves as a request form for laboratory tests, requiring detailed information about the submitter, patient, and specimen.

How to fill out laboratory test request form

How to fill out laboratory test request form

1. Start with patient identification details: Enter the patient's full name, date of birth, and identification number.
2. Specify the requesting physician's information: Include the physician's name, contact number, and address.
3. Fill in the type of test required: Clearly state the specific laboratory tests needed (e.g., blood tests, urine tests).
4. Provide clinical information: Include relevant medical history or symptoms that explain the need for the tests.
5. Indicate the date and time of the sample collection: This helps laboratories track sample validity.
6. Check for any special instructions: If the tests require fasting or specific preparation, note this on the form.
7. Sign and date the form: Ensure that the physician signs off on the request to validate it.

Who needs laboratory test request form?

1. Healthcare professionals such as physicians, nurse practitioners, or physician assistants who are diagnosing or monitoring a patient's health.
2. Patients who require testing to understand their health status or to follow up on treatments.
3. Laboratory technicians who need a formal request to perform the tests on samples provided.

For pdfFiller’s FAQs

What is laboratory test request form?

A laboratory test request form is a document used by healthcare providers to order specific laboratory tests for patients.

Who is required to file laboratory test request form?

Generally, healthcare professionals such as doctors, nurses, or physician assistants are required to file the laboratory test request form on behalf of the patient.

How to fill out laboratory test request form?

To fill out a laboratory test request form, one must provide patient information, specify the tests to be performed, include clinical information, and sign the form if required.

What is the purpose of laboratory test request form?

The purpose of the laboratory test request form is to communicate the healthcare provider's orders to the laboratory for testing and to ensure accurate and efficient processing of samples.

What information must be reported on laboratory test request form?

The information that must be reported includes patient demographics, the requested tests, clinical history, any relevant medical information, and provider identification.