Get the free Test Requisition Form

This form is used to order genomic sequencing tests and IHC stain assessments for various cancer types offered by Tempus. It includes sections for patient information, ordering physician details,

How to fill out test requisition form

How to fill out test requisition form

1. Obtain the test requisition form from the laboratory or healthcare provider.
2. Fill in the patient's personal information, including name, date of birth, and contact details.
3. Provide the patient's medical record number, if applicable.
4. Specify the required tests by checking the appropriate boxes or writing them in.
5. Indicate the reason for the tests or any relevant clinical information.
6. Enter the ordering physician's name and contact information.
7. Include any additional instructions or special handling requirements.
8. Review the form for completeness and accuracy before submission.

Who needs test requisition form?

1. Patients undergoing diagnostic testing.
2. Healthcare providers ordering laboratory tests.
3. Laboratories processing the tests.

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What is test requisition form?

A test requisition form is a document used to request laboratory tests for patients. It includes necessary information required for the lab to perform the tests accurately.

Who is required to file test requisition form?

Typically, healthcare providers such as physicians, nurse practitioners, or physician assistants are required to file a test requisition form to initiate laboratory testing for a patient.

How to fill out test requisition form?

To fill out a test requisition form, the healthcare provider must enter patient information, details of the tests requested, clinical history, and any specific instructions for the laboratory, ensuring all necessary fields are completed accurately.

What is the purpose of test requisition form?

The purpose of a test requisition form is to communicate essential information about the patient and the requested laboratory tests, ensuring accurate and timely testing and diagnosis.

What information must be reported on test requisition form?

The information that must be reported on a test requisition form includes the patient's name, date of birth, identification number, the name of the physician requesting the tests, specific tests ordered, clinical information, date of sampling, and any relevant medical history.