Get the free Infection Control Test Requisition Form

MEDICAL DIAGNOSTIC LABORATORIES, L.L.C. 2439 User Road Hamilton, NJ 08690-3303 (609) 570-1000 Fax (609) 570-1020 Toll Free (877) 269-0090 www.mdlab.com Infection Control Test Requisition Form Ordering

How to fill out infection control test requisition

How to fill out an infection control test requisition:

1. Obtain the necessary form: The infection control test requisition form can typically be obtained from your healthcare provider or the testing facility. It may also be available online for download.
2. Patient information: Start by filling out all the required fields related to the patient's information. This may include the patient's full name, date of birth, gender, contact information, and any other relevant details. Make sure to provide accurate and up-to-date information.
3. Medical history: Some requisition forms may ask for specific medical history information, such as any previous infections or underlying health conditions that could be relevant in interpreting the test results. Fill out these sections with the necessary details.
4. Test selection: Indicate the type of infection control test that needs to be conducted. This could vary based on the purpose of the test, such as screening for specific viruses or monitoring the effectiveness of infection control measures. Follow the instructions provided on the form or consult with your healthcare provider if you're unsure about the appropriate test selection.
5. Specimen collection details: Specify the type of specimen that will be collected for testing. This could include blood, urine, swab samples, or any other appropriate sample. Provide any additional instructions or requirements for the specimen collection process as indicated on the form.
6. Relevant medical personnel: Many infection control test requisitions require information about the medical professionals involved in the testing process. This may include the name of the ordering physician, the referring doctor, or any other individuals who should receive the test results.
7. Consent and signature: Review the form carefully and ensure that all sections have been properly filled out. If there is a consent section, read it thoroughly and provide your signature if required. By signing, you are acknowledging your understanding of the test and granting permission for the test to be performed.
8. Submission: Once you have completed filling out the requisition form, follow the instructions provided on how to submit it. This could involve mailing the form, bringing it in person to the testing facility, or using any online submission platforms available. Ensure that the form is submitted within the designated time frame specified on the form or by your healthcare provider.

Who needs an infection control test requisition?

Any individual who requires an infection control test may need a requisition form. This can include patients with suspected or confirmed infections, individuals at high risk for certain infections, individuals undergoing regular testing as part of infection control protocols, or healthcare professionals who work in settings that require routine testing for monitoring and prevention of infections.

It is important to consult with your healthcare provider or follow the guidance of relevant public health authorities to determine if an infection control test is necessary for your specific situation and to obtain the appropriate requisition form.

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