Get the free LABORATORY TEST REQUISITION FORM Please print clearly and

Connective Tissue Gene Tests 6575 Snowdrift Road, Suite 106, Allentown, PA 18106 Phone: (484) 2442900 Fax: (484) 2442904 (CIA # 39D1027912 CAP# 7190738 NPI# 1891864997) www.ctgt.net LABORATORY TEST

How to fill out laboratory test requisition form

How to Fill Out Laboratory Test Requisition Form:

Start by providing your personal information:

1. Write your full name, including any middle names or initials.
2. Enter your date of birth and gender.
3. Provide your contact information, including your phone number and address.
4. Write down the name of the healthcare provider or clinic that requires the tests.
5. Include their contact information, such as phone number and address.

Indicate the type of tests you need:

1. Clearly state the purpose of the tests and the specific types of tests required.
2. Include any specific requests or instructions from your healthcare provider.

Enter your insurance information (if applicable):

1. If you have health insurance coverage, provide your insurance details such as the name of the insurance company and your policy number.
2. Include any necessary information or forms required by your insurance company.

Specify the date and time preferences for the tests:

1. Indicate your preferred date and time for the tests, if applicable.
2. If there are any time constraints or specific instructions regarding when the tests should be conducted, clearly communicate them.

Provide your signature and date:

1. Sign the requisition form to confirm your authorization for the tests.
2. Write down the date when you are filling out the form.

Who Needs Laboratory Test Requisition Form?

Laboratory test requisition forms are typically needed by:

1. Patients seeking medical tests or diagnostic evaluations.
2. Healthcare providers, such as doctors, nurses, or specialists, who order specific tests for their patients.
3. Medical clinics, laboratories, or diagnostic centers responsible for conducting the tests.
4. Insurance companies that require valid requisition forms for claims processing and documentation purposes.

These forms serve as a crucial communication tool between patients, healthcare providers, and testing facilities, ensuring that the necessary tests are conducted accurately and efficiently.

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What is laboratory test requisition form?

The laboratory test requisition form is a document used to request specific tests to be performed on a patient's samples.

Who is required to file laboratory test requisition form?

Healthcare professionals such as doctors, nurses, and practitioners are required to file laboratory test requisition forms on behalf of their patients.

How to fill out laboratory test requisition form?

The form typically requires the patient's personal information, the tests being requested, the reason for the testing, and relevant medical history.

What is the purpose of laboratory test requisition form?

The purpose of the form is to ensure that the correct tests are performed on the patient's samples and that the results are accurately reported to the healthcare provider.

What information must be reported on laboratory test requisition form?

The form must include the patient's name, date of birth, date of sample collection, tests requested, reason for testing, healthcare provider's information, and patient's medical history.