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CLINICAL LAB REQUEST PT. NO.UW MEDICINE CLINICAL IMMUNOLOGY LA BUW LAB ACC. #Printer RequisitionNAME (Last, First)D.O.B.Completely fill in left section. MSN: XXXIX NOTE:FClearLOGGED IN BY:PROCESSED

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How to fill out clinical lab request

01

Obtain a clinical lab request form from your healthcare provider.

02

Fill out your personal information, including your name, date of birth, address, and contact information.

03

Provide details about your healthcare provider, including their name, address, and contact information.

04

Specify the tests you are requesting by providing the name or code of the test, along with any additional instructions.

05

If necessary, indicate the preferred date and time for the laboratory test.

06

Review the completed form for accuracy and make any necessary corrections.

07

Sign and date the form to indicate your consent for the requested tests.

08

Submit the filled-out clinical lab request form to the designated laboratory for processing.

Who needs clinical lab request?

01

Anyone who requires laboratory tests to aid in diagnosis or treatment of a medical condition needs a clinical lab request.

02

This includes individuals seeking routine health check-ups, those with suspected infections or diseases, patients undergoing medical procedures or surgeries, and individuals monitoring their overall health and well-being.

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