Get the free Laboratory specimen submission Form for Influenza , including novel - acphd

Alameda County Public Health Laboratory 499 Fifth Street, Room 403 Oakland, CA 94607 James R. Carlson, Ph.D., Laboratory Director Tel: (510) 268-2700 Fax: (510) 268-2709 CIA: #05D0601931 Laboratory

How to fill out laboratory specimen submission form

How to fill out a laboratory specimen submission form:

1. Gather all necessary information: Before starting to fill out the form, make sure you have all the required information, such as patient details, specimen type, and relevant medical history.
2. Begin with patient information: Fill in the patient's full name, date of birth, gender, and contact information. This ensures accurate identification and communication.
3. Specify ordering physician: Record the name, address, and contact details of the physician who requested the lab test. This information helps in proper communication of results and clarifications, if required.
4. Provide insurance details (if applicable): If the patient has insurance coverage, include the insurance information, policy number, and any relevant authorizations. This helps to ensure proper billing and reimbursement.
5. Indicate the type of specimen: Clearly identify the type of specimen being submitted, such as blood, urine, tissue, or other. This information is crucial for the laboratory to process the sample correctly.
6. Include date and time collection: Record the specific date and time when the specimen was collected. This helps to maintain proper tracking and ensure timely analysis.
7. Include any special instructions: If there are any specific instructions or requirements for handling the specimen, include them in this section. For instance, certain tests may require the specimen to be refrigerated or transported in a specific manner.
8. Provide relevant medical history: Include any pertinent medical history or clinical information that may aid the laboratory in interpreting the test results. This can include details of medications the patient is taking, recent surgeries, or any known allergies.
9. Sign and date the form: Ensure that the form is signed and dated by the ordering physician or authorized healthcare provider. This signature confirms the validity and consent for the laboratory test.

Who needs laboratory specimen submission form:

1. Patients requiring diagnostic tests: Any individual who needs to undergo laboratory testing or provide a specimen for analysis will require a laboratory specimen submission form. This can include patients seeking routine check-ups, diagnostic screenings, or specific health concerns.
2. Healthcare providers: Physicians, nurses, or other healthcare professionals who are ordering laboratory tests on behalf of their patients will need to complete a laboratory specimen submission form. This form helps to ensure accurate identification, proper sample handling, and effective communication of results.
3. Laboratories and testing facilities: Staff at laboratory and testing facilities require the specimen submission form to accurately record patient information, track samples, and process the tests requested. It acts as a reference throughout the entire testing process.

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What is laboratory specimen submission form?

The laboratory specimen submission form is a document used to submit specimens for testing in a laboratory. It provides important information about the specimen and the desired tests to be performed.

Who is required to file laboratory specimen submission form?

Anyone who needs to submit specimens for testing in a laboratory is required to file a laboratory specimen submission form. This includes healthcare professionals, researchers, and individuals seeking diagnostic tests.

How to fill out laboratory specimen submission form?

To fill out a laboratory specimen submission form, you need to provide information such as the patient's name and identification number, specimen type, desired tests, and any relevant clinical information. The specific instructions for filling out the form may vary depending on the laboratory.

What is the purpose of laboratory specimen submission form?

The purpose of the laboratory specimen submission form is to ensure accurate and efficient processing of specimens in a laboratory. It helps the laboratory staff to properly identify and handle the specimens, perform the requested tests, and report the results to the appropriate parties.

What information must be reported on laboratory specimen submission form?

The laboratory specimen submission form typically requires information such as the patient's name and identification number, specimen type and source, desired tests, date and time of collection, and any relevant clinical information that may assist in the interpretation of test results.