Get the free Fairbanks Lab Request Form - dhss alaska

A request form used for submitting laboratory tests and specimens at the Alaska State Virology Laboratory, including sections for patient and specimen information.

How to fill out fairbanks lab request form

How to fill out Fairbanks Lab Request Form

1. Begin by entering the patient's information including name, date of birth, and contact details.
2. Fill in the referring physician's details including name and contact number.
3. Indicate the tests required by checking the appropriate boxes for each test.
4. Provide any relevant clinical information or symptoms to assist with the testing.
5. Include the patient's insurance information, if applicable.
6. Sign and date the form to authenticate it before submission.
7. Submit the completed form to Fairbanks Lab along with the patient samples.

Who needs Fairbanks Lab Request Form?

1. Healthcare providers who need to order laboratory tests for their patients.
2. Clinics and hospitals requiring lab results to support diagnoses.
3. Patients needing specific tests ordered by their physicians.

People Also Ask about

What is a medical laboratory request form?

Laboratory request forms provide information about the laboratory test being requested for. They carry demographic data and other information such as location of patient, laboratory number, doctor's name, signature of the doctor, telephone number of the requesting doctor.

What information should be on a lab request form?

Laboratory Instructions for Completion of Routine Request Forms Enter first and last name. Enter phone and fax numbers for handling of results. Patient Information. Please print clearly, using a pen. Enter patient last name, suffix (Jr., Sr., III), first name, middle initial. Mark sex—M or F—many tests are sex-related.

What information must be included on a laboratory request for?

Patient details (name, address, telephone number, birth date, gender, etc.) Requester details. Type of primary sample. Examination(s) requested.

How long does a lab request last?

Can I come in and be tested or do I need to go back to my doctor for a new form? Most test orders are valid for at least six months (unless your doctor has specified otherwise). If your lab testing order is more than six months old, please contact your doctor for a new form. Was this helpful?

What is the purpose of a lab requisition form?

A test requisition form is used by healthcare professionals to request laboratory tests such as or blood testing. Test requisition forms are often called lab forms. When blood, , or tissue is sent to a lab from a doctor's office a test requisition form is required.

What is a laboratory request form?

Background information: The laboratory request form is a communication link between the clinicians and the laboratory staff. It contains demographic details of the patient including full names, age and gender; the test required; location of the patient; date and time of request among other details.

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What is Fairbanks Lab Request Form?

The Fairbanks Lab Request Form is a document used to request laboratory testing services from Fairbanks Laboratories.

Who is required to file Fairbanks Lab Request Form?

Individuals or organizations seeking laboratory tests or analyses must file the Fairbanks Lab Request Form.

How to fill out Fairbanks Lab Request Form?

To fill out the Fairbanks Lab Request Form, provide accurate details including the type of test required, patient information, and any necessary medical history.

What is the purpose of Fairbanks Lab Request Form?

The purpose of the Fairbanks Lab Request Form is to formally request laboratory services and ensure that all necessary information is collected for accurate testing.

What information must be reported on Fairbanks Lab Request Form?

The Fairbanks Lab Request Form must include information such as patient name, contact details, test type, physician information, and pertinent medical history.