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TEST REQUISITION PLEASE PRINTPROVIDER/ACCOUNT INFORMATIONSAMPLE COLLECTION INFORMATION DATE COLLECTED (required):ACCOUNT NAME/ADDRESS:TIME COLLECTED: PATIENT ID#: SENDER SAMPLE ID#:PHONE #:PROVIDER/NPI#:MEDICARE

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How to fill out sample collection information

01

Start by gathering all the necessary sample collection forms and materials.

02

Carefully read and understand the instructions provided on the sample collection form.

03

Fill out the personal information section accurately, including your full name, date of birth, and contact information.

04

Follow the specific guidelines for collecting the sample. This may involve taking a blood, urine, or saliva sample, or any other type of specimen.

05

Pay close attention to any specific instructions related to the handling and storage of the sample.

06

Ensure that the sample is properly labeled with your identification details to avoid any mix-up or confusion.

07

Double-check all the information filled on the sample collection form for any errors or discrepancies.

08

Submit the completed sample collection form along with the collected sample to the designated laboratory or healthcare facility.

09

Keep a copy of the sample collection form and any associated documentation for your records.

Who needs sample collection information?

01

Sample collection information is needed by healthcare professionals, clinical laboratories, research institutes, and various medical facilities.

02

It is also required by regulatory bodies, such as the Food and Drug Administration (FDA), to ensure proper sample handling and documentation.

03

Patients or individuals providing the samples may also need this information for their own records or when communicating with healthcare providers.

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What is sample collection information?

Sample collection information refers to data or details regarding the collection process of various samples for testing or analysis purposes.

Who is required to file sample collection information?

Individuals or organizations involved in collecting samples for testing or analysis purposes are required to file sample collection information.

How to fill out sample collection information?

Sample collection information can be filled out by providing details such as the type of samples collected, the date and time of collection, the location, and any specific instructions or requirements for handling the samples.

What is the purpose of sample collection information?

The purpose of sample collection information is to document and track the collection process, ensuring transparency and accuracy in sample handling and testing procedures.

What information must be reported on sample collection information?

Information such as sample type, collection date and time, location, identification of collector, and any special handling instructions must be reported on sample collection information.

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