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CLINICAL TEST REQUISITION STATE OF CONNECTICUTSubmitter Facility Name/AddressACCESSION LABEL Dr. Katherine A. Kelley State Public Health Laboratory 395 West Street, Rocky Hill, CT 06067 CLI AID 07D0644555
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How to fill out clinical test requisition
How to fill out clinical test requisition
01
Step 1: Obtain the clinical test requisition form from your healthcare provider.
02
Step 2: Fill in your personal information accurately, including your full name, date of birth, gender, and contact information.
03
Step 3: Provide your healthcare provider's information, including their name, contact number, and clinic or hospital name.
04
Step 4: Specify the type of clinical tests you require by checking the appropriate boxes or writing the names of the tests.
05
Step 5: Indicate the date and time of your appointment for the tests, if applicable.
06
Step 6: Provide any additional information or special instructions as instructed by your healthcare provider.
07
Step 7: Review the completed form for any errors or missing information.
08
Step 8: Sign and date the form to acknowledge your consent and agreement with the test requisition.
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Step 9: Submit the filled-out clinical test requisition form to the designated laboratory or facility.
Who needs clinical test requisition?
01
Anyone who requires specific clinical tests as recommended by their healthcare provider needs a clinical test requisition.
02
This may include patients undergoing medical investigations, individuals seeking routine health check-ups, or individuals participating in research studies or clinical trials.
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What is clinical test requisition?
Clinical test requisition is a document that requests for specific medical tests to be conducted on a patient.
Who is required to file clinical test requisition?
Medical practitioners, physicians, or healthcare providers are required to file clinical test requisition.
How to fill out clinical test requisition?
Clinical test requisition can be filled out by providing patient information, specific tests requested, and any other relevant details.
What is the purpose of clinical test requisition?
The purpose of clinical test requisition is to ensure that necessary medical tests are conducted on a patient to aid in diagnosis and treatment.
What information must be reported on clinical test requisition?
Patient's name, date of birth, tests requested, healthcare provider's information, and any relevant clinical history must be reported on clinical test requisition.
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