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OUTPATIENT LABORATORY REQUESTPatient Name: Date of Birth: Social Security Number: Insurance Employer PANELS Chemistry Panels Electrolytes Panel Basic Metabolic Panel Comprehensive Metabolic Panel
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How to fill out outpatient lab request
How to fill out outpatient lab request
01
Obtain the outpatient lab request form from the healthcare provider.
02
Fill in the patient’s personal information such as name, date of birth, and contact information.
03
Provide details of the tests or procedures requested by the healthcare provider.
04
Include any relevant medical history or insurance information if required.
05
Sign and date the form as the requesting healthcare provider or patient.
06
Submit the completed form to the lab for processing.
Who needs outpatient lab request?
01
Patients who have been referred by a healthcare provider for specific lab tests or procedures.
02
Healthcare providers who require diagnostic information to assist in patient care and treatment.
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What is outpatient lab request?
An outpatient lab request is a form or order submitted by a healthcare provider to request laboratory testing for a patient who is not admitted to a hospital.
Who is required to file outpatient lab request?
Healthcare providers such as doctors, nurse practitioners, or physician assistants are required to file outpatient lab requests.
How to fill out outpatient lab request?
An outpatient lab request form typically requires the provider to input the patient's demographic information, the specific tests to be performed, and any relevant clinical information.
What is the purpose of outpatient lab request?
The purpose of an outpatient lab request is to guide laboratory technicians in performing the necessary tests to diagnose, monitor, or treat a patient's condition.
What information must be reported on outpatient lab request?
The outpatient lab request must include the patient's name, date of birth, medical record number, tests to be performed, reason for testing, and the provider's signature.
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