Get the free Lab Test Requisition Form

This form is used for the submission of laboratory test requests by various healthcare facilities in Sacramento County. It collects patient information, specimen details, and the type of tests being requested, including microbiology, virology, serology, and more. The form ensures that specimens are properly labeled and provides guidelines for submission to the California Public Health Laboratory.

How to fill out lab test requisition form

How to fill out lab test requisition form

1. Gather patient information: Include the patient's full name, date of birth, and contact information.
2. Fill in the physician's details: Write the name and contact information of the ordering physician.
3. Specify the tests required: Clearly indicate which lab tests are requested from the list provided.
4. Provide patient demographics: Indicate the patient's gender, insurance information, and any other relevant demographic details.
5. Indicate clinical information: Include any necessary clinical history or symptoms that justify the tests.
6. Review and verify: Double-check all entries for accuracy and completeness before submission.
7. Sign and date: Ensure the requisition form is signed and dated by the ordering physician.

Who needs lab test requisition form?

1. Healthcare providers who need to request laboratory tests for patient diagnosis or monitoring.
2. Patients who are referred for testing by their physician.
3. Clinics, hospitals, and laboratories that require documentation for processing tests.

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What is lab test requisition form?

A lab test requisition form is a document used by healthcare providers to request specific laboratory tests for a patient. It typically includes patient information, the tests requested, and clinical details.

Who is required to file lab test requisition form?

Healthcare providers, such as doctors and nurse practitioners, are required to file a lab test requisition form when ordering laboratory tests for their patients.

How to fill out lab test requisition form?

To fill out a lab test requisition form, provide the patient's personal information, select the required lab tests, add relevant clinical information, and include the provider's information and signature.

What is the purpose of lab test requisition form?

The purpose of a lab test requisition form is to communicate the healthcare provider's request for laboratory testing, ensuring that accurate and necessary tests are conducted for the patient's medical evaluation.

What information must be reported on lab test requisition form?

The information that must be reported on a lab test requisition form includes the patient's name, date of birth, contact information, the specific tests requested, clinical notes, and the provider's details.