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LAST NAME MR# NAME: MR# FIRST NAME Department of Pathology & Laboratory Medicine LAB1500 LAB REQUISITION Rev. 11/07 DOB OR Date: PLACE PATIENT LABEL HERE Routine I STAT I ALP SPAN ANA ANC Diagnosis/ICD9:
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How to fill out core lab requisition form
How to fill out core lab requisition form
01
Read the instructions carefully and ensure you have all the necessary information.
02
Start by filling out the patient demographics section, including the patient's name, date of birth, and contact information.
03
Provide the reason for the lab test in the corresponding section.
04
Indicate the type of specimen to be collected (blood, urine, etc.) and the required tests.
05
Include any special instructions or additional information that may be relevant for the lab technician.
06
Ensure all necessary signatures and dates are included.
07
Review the completed form for accuracy and completeness before submitting it to the lab.
Who needs core lab requisition form?
01
Medical professionals such as doctors, nurses, and healthcare providers who require specific lab tests for their patients.
02
Patients who have been instructed by their healthcare provider to undergo laboratory testing.
03
Research institutions or organizations conducting studies that involve collecting and analyzing laboratory specimens.
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What is core lab requisition form?
The core lab requisition form is a document used to request laboratory tests or procedures.
Who is required to file core lab requisition form?
Healthcare providers or physicians are required to file the core lab requisition form.
How to fill out core lab requisition form?
The core lab requisition form must be filled out with patient information, requested tests, and physician signature.
What is the purpose of core lab requisition form?
The purpose of the core lab requisition form is to ensure proper documentation and communication of laboratory test requests.
What information must be reported on core lab requisition form?
The core lab requisition form must include patient name, date of birth, tests requested, physician information, and specimen details.
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