Get the free Sample Requisition - Acupath Laboratories, Inc.

TEL # 1-888- PATH (228-7284) TEL # (516) 775-8103 FAX # (516) 326-3452 28 S. TERMINAL DRIVE, PLAINTIFF, NY 11803 WWW.ACUPATH.COM SURGICAL PATHOLOGY TEST REQUEST FORM SP001L ANY OMISSION MAY RESULT

How to fill out sample requisition - acupath

How to Fill Out Sample Requisition - Acupath:

1. Start by writing down the patient's personal information, including their full name, date of birth, and contact information. This information is crucial for proper identification and communication purposes.
2. Next, provide the patient's insurance information, including the insurance company name, policy number, and group number. This helps Acupath understand the patient's coverage and process the requisition accordingly.
3. Specify the referring physician's information, including their name, contact details, and any relevant identification numbers or codes. This ensures that Acupath can communicate and coordinate with the referring physician effectively.
4. Indicate the reason for the requisition. Include any relevant clinical information, such as symptoms, medical history, or suspected conditions. This helps Acupath understand the context and purpose of the requested tests.
5. Select the specific tests or procedures needed from Acupath's sample requisition form. There may be checkboxes or fields to specify the type of test, the desired test panel, or any additional instructions. Ensure that you accurately indicate the tests required for accurate processing.
6. If there are any special instructions or considerations, make sure to note them clearly. This may include fasting requirements, medication restrictions, or specific sample collection instructions. Providing these details helps Acupath ensure the accuracy and reliability of the test results.
7. Review the completed requisition form for any errors or missing information. Double-check that all the necessary fields have been filled out correctly, and there are no spelling mistakes or inconsistencies. Accuracy in filling out the form is crucial for proper test processing.
8. Once you have reviewed the form, sign and date it to confirm your authorization and agreement with the provided information. This signature indicates that the patient or the responsible party accepts responsibility for payment, understands the purpose of the tests, and authorizes Acupath to conduct the requested tests.

Who needs sample requisition - Acupath?

1. Patients who require diagnostic testing to aid in the diagnosis or management of their medical condition.
2. Physicians or healthcare providers who are referring their patients for specialized pathology or laboratory testing services.
3. Insurance companies or third-party payers who require the sample requisition to process and approve the coverage and payment for the requested tests.

Note: It is always recommended to consult with the healthcare provider or Acupath directly for any specific instructions or requirements regarding the sample requisition process.

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