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Mercy Lab Requisition Form STAT CLIENT ACCOUNT INFORMATION PATIENT Last Name DOB (MM/DD/BY) Send Duplicate Report to: Physician Name Subscriber Name Group Policy # State City ICD CODES (enter all

How to fill out mercy lab requisition form

How to fill out Mercy Lab Requisition Form:

1. Start by gathering all the required information: Make sure you have the patient's full name, date of birth, and contact information. You will also need the ordering physician's name, address, and contact details.
2. Identify the tests needed: Consult with the ordering physician to determine the specific lab tests required for the patient. This could include blood work, urine analysis, or other specialized tests.
3. Provide clinical information: Fill in the relevant clinical information section of the form. This may include the reason for the lab tests, the patient's medical history, and any specific instructions or notes from the physician.
4. Specify the type of specimen: Indicate the type of specimen being submitted for testing, whether it's blood, urine, tissue, or any other required sample. Ensure that the quantity or volume of the sample is also mentioned.
5. Include insurance or billing information: If required, provide the patient's insurance details or any billing information that may be necessary for processing the lab request.
6. Complete the requisition form: Carefully fill out all the necessary fields on the Mercy Lab Requisition Form, ensuring accuracy and legibility. Double-check for any missing or incomplete information before submitting the form.
7. Who needs Mercy Lab Requisition Form: Anyone who requires laboratory testing ordered by a physician will need to fill out the Mercy Lab Requisition Form. This form acts as a formal request for laboratory analysis and includes all the necessary information for the lab to perform the requested tests.
8. Submit the form: Once the form is completed, submit it to the appropriate department or clinic. Follow any additional instructions provided by the healthcare provider or institution regarding the submission process.

Remember, it is important to understand that each institution may have specific guidelines or variations for filling out the Mercy Lab Requisition Form, so it is always advisable to seek guidance from the healthcare provider or laboratory staff if any questions or concerns arise.

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What is mercy lab requisition form?

Mercy lab requisition form is a document used to request laboratory tests or services from the Mercy Health network.

Who is required to file mercy lab requisition form?

Healthcare providers, physicians, or clinicians who are ordering laboratory tests for patients are required to fill out the mercy lab requisition form.

How to fill out mercy lab requisition form?

To fill out the mercy lab requisition form, one must provide patient information, test(s) requested, ordering physician information, and any relevant clinical notes.

What is the purpose of mercy lab requisition form?

The purpose of the mercy lab requisition form is to ensure accurate communication of test requests between healthcare providers and the laboratory, leading to proper diagnosis and treatment for patients.

What information must be reported on mercy lab requisition form?

Patient demographics, test(s) requested, clinical history, ordering physician information, and any specific instructions or special requirements for the tests must be reported on the mercy lab requisition form.