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Fax 91-11-3040 3204 E-mail lalpathlabs lalpathlabs. com Website www. lalpathlabs. com COAGULATION REQUISITION FORM Lab No.. APTT Normal Abnormal History of Drug / Medication if any for Coagulation Disorder Current dose Date of last change in dose Oral Anticoagulant i Warfarin / Acetrom ii Hirudin iii Coumarin I. Doc No* LPL/R/QF/2714 National Reference Laboratory Sector 18 Block E Rohini New Delhi 110 085 Tel 91-11- 3040 3210 3988 5050. Type of specimen Date. Fasting Non-fasting Male Female Tel...No* 1. Patient. 2. Physician. Clinical History A. Bleeding Disorder I. Congenital B. No II. Acquired Yes Thromobotic Disorder C. History of blood transfusion / blood products If yes when. History of Laboratory investigations Prothrombin Time If yes Last value of INR Liver function test if performed Others specify Date. V. infusion i Low Molecular weight Heparin ii Unfractionated heparin History of major surgery e*g* Cardiac / Neurosurgery in last one year Probable Diagnosis. Type of specimen...Date. Fasting Non-fasting Male Female Tel No* 1. Patient. 2. Physician. Clinical History A. Bleeding Disorder I. Congenital B. No II. Acquired Yes Thromobotic Disorder C. History of blood transfusion / blood products If yes when. Bleeding Disorder I. Congenital B. No II. Acquired Yes Thromobotic Disorder C. History of blood transfusion / blood products If yes when. History of Laboratory investigations Prothrombin Time If yes Last value of INR Liver function test if performed Others specify Date....Type of specimen Date. Fasting Non-fasting Male Female Tel No* 1. Patient. 2. Physician. Clinical History A. Bleeding Disorder I. Congenital B. No II. Acquired Yes Thromobotic Disorder C. History of blood transfusion / blood products If yes when. History of Laboratory investigations Prothrombin Time If yes Last value of INR Liver function test if performed Others specify Date.

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Comprehensive Guide to the Coagulation Requisition Form

What is a coagulation requisition form?

A coagulation requisition form is a document used by healthcare providers to request laboratory testing of blood coagulation factors. This form is crucial as it ensures that all necessary patient information and test requirements are communicated to the laboratory, facilitating accurate and timely testing.

The form typically captures patient demographics, medical history, and specific diagnostic tests requested, which are essential for laboratory processes and patient safety.

How can access the coagulation requisition form?

Visit pdfFiller to locate the coagulation requisition form. You can easily search for medical forms in their user-friendly interface.
Download the PDF or access it directly from the cloud. This flexibility allows you to fill out the form electronically or print it as necessary.
The form is compatible across various devices including computers, tablets, and smartphones, ensuring accessibility wherever you are.

What should include when filling out the coagulation requisition form?

Filling out the coagulation requisition form correctly is critical for adequate testing. Include essential patient information fields such as Lab Number, Type of Specimen, and accurate patient details including Name, Age, Sex, and Contact Number.

Moreover, it is essential to provide physician information to streamline communication between the lab and the referring physician.

What clinical history should be documented?

Indicate whether the patient has congenital or acquired bleeding disorders to inform appropriate testing.
Document any history of thrombotic disorders. This information can significantly influence test results and treatment.
Record any recent blood transfusions or laboratory investigations to provide context for the testing.

What guidelines should follow for specimen collection?

Following precise guidelines for specimen collection is essential for accurate results. Be aware of the times and dates for specimen collection, as accuracy in timing can impact test outcomes.

Differentiate between fasting and non-fasting samples as this can determine the validity of the tests performed. It's crucial to provide clear instructions for sample collection personnel to minimize errors.

What medicational history is required?

Provide details of any ongoing anticoagulant medications including current doses.
It is necessary to track any recent changes in medications, as these can influence coagulation test results.
Include sections for both Oral Anticoagulants and I.V. Infusions to ensure a comprehensive overview of the patient's medication.

What additional diagnostic information should be included?

Make sure to provide possible diagnosis fields on the form. This includes mentioning any recent major surgeries, as they may influence the patient’s clotting ability.

Fill out the probable diagnosis sections to give the laboratory context that is vital for accurate interpretation of the coagulation tests.

How can pdfFiller assist in managing my coagulation requisition form?

pdfFiller provides an efficient platform for managing your coagulation requisition form with features that enhance usability. You can easily edit forms, ensuring they are up-to-date with the latest patient information.

Collaborative features allow for team-based management of the requisition form, making it easier to coordinate between medical staff and laboratories. Additionally, eSigning functionalities streamline processes, making it a valuable tool for both individuals and healthcare teams.

Frequently Asked Questions about coagulation requisition form

What information do I need to provide on a coagulation requisition form?

You need to include essential patient information such as Lab Number, patient demographic details, clinical history, and any medicational history relevant to anticoagulants. Specifics about recent surgeries and blood transfusions should also be documented.

Where can I find the coagulation requisition form?

You can access the coagulation requisition form on pdfFiller's website. It’s available for download as a PDF or for direct filing online, adaptable for various devices.

How important is specimen collection timing?

Timing is crucial for specimen collection, as it can affect the accuracy of test results. Ensuring correct collection conditions, such as fasting status, is equally important.

What are the benefits of using pdfFiller for this form?

Using pdfFiller allows for seamless editing, collaboration among medical staff, and easier access to eSigning features. This platform enhances the overall management of documents, improving efficiency in healthcare settings.

Can I edit the coagulation requisition form online?

Yes, pdfFiller allows you to edit the coagulation requisition form online easily. This feature ensures that the most current patient information is always recorded, enhancing accuracy and communication.