Lifelabs Surgical Pathology Requisition Form 2018-2025 free printable template

SurgiCAl PAThOlOgY requiSiTiOn Laboratory Use Only Name Requesting Clinician/Practitioner Clinician/Practitioner Phone Number Address Health Card Number HCN Province Copy to Clinician s /Practitioner s fill in all fields Patient Last Name as per Health Card Billing F Date of Birth YYYY / MO / dA Patient Telephone Number Patient Address including postal code Specimen Other Province s Registration Number Gender M Patient First Middle Name as per Health Card Patient Chart Number Version S89057...

How to fill out lifelabs pathology form

How to fill out Lifelabs Surgical Pathology Requisition Form

1. Obtain the Lifelabs Surgical Pathology Requisition Form from the Lifelabs website or your healthcare provider.
2. Fill in the patient's personal information including name, date of birth, and contact details.
3. Provide the referring physician's information including name, contact number, and address.
4. Specify the type of procedure or surgery performed.
5. Indicate the specimen details including type of tissue and any specific requests for testing.
6. Complete the clinical history section with relevant medical information.
7. Ensure all required signatures are provided from both the referring physician and the patient when necessary.
8. Review the form for completeness and accuracy before submission.
9. Submit the completed form along with the specimen to the designated Lifelabs location.

Who needs Lifelabs Surgical Pathology Requisition Form?

1. Healthcare providers who need histopathological analysis of surgical specimens.
2. Patients undergoing surgical procedures where tissue samples are collected for diagnosis.
3. Medical professionals requiring a formal documentation for specimen testing and analysis.

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What is Lifelabs Surgical Pathology Requisition Form?

The Lifelabs Surgical Pathology Requisition Form is a document used by healthcare providers to request pathological examinations and analyses of tissue samples.

Who is required to file Lifelabs Surgical Pathology Requisition Form?

Healthcare professionals, such as doctors or surgeons, who need a pathological evaluation of a specimen must file the Lifelabs Surgical Pathology Requisition Form.

How to fill out Lifelabs Surgical Pathology Requisition Form?

To fill out the form, you need to provide patient information, specimen details, clinical history, and the specific tests requested. Ensure all sections are completed accurately.

What is the purpose of Lifelabs Surgical Pathology Requisition Form?

The purpose of the form is to facilitate the collection, identification, and analysis of tissue specimens for diagnostic purposes and to ensure proper processing in the laboratory.

What information must be reported on Lifelabs Surgical Pathology Requisition Form?

The form must report the patient's name, date of birth, physician's name, date of the procedure, sample type, clinical history, and any specific instructions or tests required.