Get the free Phlebotomy Services Request Form for Research Study - UAB

Phlebotomy Services Request Form for Research Study Date: Patient Name: MR # (If Applicable): DOB: Written diagnosis (not a code): Not applicable for research patient Reason for test: Not applicable

How to fill out phlebotomy services request form

How to fill out phlebotomy services request form

1. Obtain a copy of the phlebotomy services request form.
2. Start by filling out the patient information section. Include the patient's full name, date of birth, address, and contact information.
3. Provide details about the ordering healthcare professional. This should include their name, contact information, and any relevant identification or license numbers.
4. Indicate the date and time of the requested phlebotomy service.
5. Specify the type of service needed, such as blood draw, specimen collection, or other specific instructions.
6. If there are any special requirements or instructions for the phlebotomy technician, include them in the appropriate section.
7. Make sure to sign and date the form to confirm its accuracy and completeness.
8. Double-check all the information provided before submitting the form to avoid any errors or delays in service.
9. Submit the completed form to the appropriate department or healthcare facility as directed.

Who needs phlebotomy services request form?

1. The phlebotomy services request form is typically needed by healthcare professionals, such as doctors, nurses, or medical laboratory staff, who require phlebotomy services for their patients.
2. This form helps ensure accurate and timely blood or specimen collection by providing all the necessary information about the patient and the requested service.
3. Patients who require phlebotomy services may also need to fill out this form if instructed by their healthcare provider.

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What is phlebotomy services request form?

Phlebotomy services request form is a document used to request phlebotomy services, which involves drawing blood for medical testing or donation.

Who is required to file phlebotomy services request form?

Doctors, nurses, medical assistants, and other healthcare professionals who need phlebotomy services for their patients are required to file the form.

How to fill out phlebotomy services request form?

The form typically requires information such as patient's name, date of birth, medical record number, type of test needed, and physician's signature.

What is the purpose of phlebotomy services request form?

The purpose of the form is to ensure that the correct tests are performed on the correct patients, and to provide documentation of the need for phlebotomy services.

What information must be reported on phlebotomy services request form?

Patient's name, date of birth, medical record number, type of test needed, and physician's signature are typically reported on the form.