Get the free Hematology and Coagulation Requisition Form

This document serves as a requisition form for laboratory testing in hematology and coagulation at The Children\'s Hospital of Philadelphia. It includes sections for patient identification, specimen type, clinical history, and various hematology and coagulation tests along with their respective EAP codes.

How to fill out hematology and coagulation requisition

How to fill out hematology and coagulation requisition

1. Obtain the hematology and coagulation requisition form.
2. Fill in the patient's full name and demographic information.
3. Provide the patient's date of birth and medical record number if applicable.
4. Indicate the date and time of the sample collection.
5. Specify the type of tests required (e.g., CBC, PT, aPTT).
6. Add the clinician's information, including name and contact details.
7. Write any special instructions or clinical history relevant to the tests.
8. Ensure that the patient's insurance information is included if needed.
9. Review the form for completeness and accuracy before submission.
10. Submit the requisition along with the blood sample to the laboratory.

Who needs hematology and coagulation requisition?

1. Patients who require diagnostic evaluation of blood disorders.
2. Individuals at risk for clotting or bleeding disorders needing assessment.
3. Healthcare providers managing conditions like anemia, leukemia, or thrombocytopenia.
4. Patients undergoing surgery or treatment that may affect blood coagulation.

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What is hematology and coagulation requisition?

Hematology and coagulation requisition is a formal request for laboratory tests related to blood conditions, including blood cell counts and clotting factors.

Who is required to file hematology and coagulation requisition?

Healthcare providers, including physicians and medical practitioners, are required to file hematology and coagulation requisitions on behalf of their patients.

How to fill out hematology and coagulation requisition?

To fill out a hematology and coagulation requisition, providers should complete patient information, specify tests required, and sign the form.

What is the purpose of hematology and coagulation requisition?

The purpose is to diagnose blood disorders, monitor conditions, and assess the risk of bleeding or clotting.

What information must be reported on hematology and coagulation requisition?

Reported information includes patient demographics, specific tests requested, clinical history, and healthcare provider details.