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RECEIVED: FILLED/INITIALS:LABORATORY SUPPLIES REQUISITION 150 E. Holt Blvd., Ontario, CA 91761 Phone (909) 4589430 Fax (909) 9863590 PROGRAM: ADDRESS: CITY / ZIP CODE:NAME: PHONE: DATE:PLEASE ALLOW
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01
Open the lab requisition form pdf file on your computer or device.
02
Read the instructions and requirements mentioned on the form thoroughly.
03
Fill out the patient's personal information accurately, including their name, date of birth, gender, and contact details.
04
Provide the necessary medical information, such as the reason for the lab test, relevant medical history, and any medications the patient is currently taking.
05
Specify the type of test(s) required by checking the appropriate boxes or writing them down in the designated spaces.
06
If applicable, mention any special instructions or additional tests requested by the healthcare provider.
07
Ensure that the form is signed and dated by the healthcare provider requesting the lab tests.
08
Double-check all the entered information for accuracy and completeness.
09
Save a copy of the filled-out lab requisition form for your records, if required.
10
Print the completed form and submit it to the designated laboratory or healthcare facility where the tests will be conducted.

Who needs lab requisition form pdf?

01
Lab requisition forms in pdf format are needed by healthcare providers, doctors, physicians, and other medical professionals who require specific laboratory tests to be performed on their patients.
02
Patients who have been referred for medical tests by their healthcare providers also need lab requisition forms in pdf format to provide the necessary information to the laboratory or testing facility.
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The lab requisition form pdf is a document used to request laboratory tests or services.
Healthcare providers or clinicians are required to file lab requisition form pdf when requesting laboratory tests for a patient.
To fill out the lab requisition form pdf, the healthcare provider must provide information about the patient, the tests requested, and any relevant clinical information.
The purpose of the lab requisition form pdf is to communicate the specific tests or services requested by the healthcare provider to the laboratory staff.
The lab requisition form pdf must include the patient's name, date of birth, tests requested, healthcare provider's information, and any relevant clinical information.
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