401-222-5600; Fax: 401-222-6985; TTY: 800-745-5555. www.health.ri.gov Forms. Contact us for detailed information on various types of test requisition forms – we’d be happy to help. Unfortunately ISO implementation is frequently accompanied by misunderstandings. There are two types of test requisition forms: piggy back labels; and integrated bar code labels. SELECT AGENT RULE OUT REQUISITION (PH-4263) COVID-19 TEST REQUISITION FORM (PH-4360) DOT Guide to Packaging Catergory B Samples Poster; DOT Safety Advisory Notice for the Transportation of COVID-19 Diagnostic Samples About Laboratory Services. OAHPP collection of personal health information on this form is collected under the authority of the Personal Health Information Protection Act, s.36 (1)(c)(iii). Under “Additional Information”, any additional clarification for the beneficiary may be entered. HealthLab Requisition. Accession List 25 34. This information will allow the laboratory to effectively review the test order and perform the appropriate test(s). Test requisition forms are often called lab forms. It should at least add the name, department and contact details of the party. A laboratory test order is required (i.e., paper requisition, electronic medical record, ChildLink TM provider). Please fill in the patient’s name and Identification Number (Medicare #). Instructions for Completing a Test Requisition Form. The ABN only needs to be signed by the patient if the physician feels that the diagnosis code may not be appropriate (not medically necessary) for the test ordered. Post Vasectomy Analysis Requisition (June 2019 Version) Specimen Collection for Fertility Requisition (June 2019 Version) Laboratory Services Manuals. The Great Plains Laboratory, Inc., 11813 West 77th Street, Lenexa, KS, 66214, United States (913) 341-8949 customerservice@gpl4u.com This information is a second verification for the lab doing the testing. The barcode labels are used to identify corresponding containers with sample to be tested. Refer to Patient Instruction Sheet. A scanner on a computer shines LED or laser light on to barcode. Lake Orion, MI 48362, Magnetic Business Cards, Car and Calendar Magnets, Test Requisition Forms with Barcode Labels. OTHER TESTING REQUESTS - Please check specimen collection and storage requirements prior to collection Lipase * Indicates tests that may need advanced beneficiary notice (ABN) refer to local and national necessity guide. In addition, if a handwritten name and a label are on the container, the information must match exactly. RIDOH State Health Laboratories Test Requisition . Department Memorandum No. For use only by authorized healthcare providers For more information on test requisition forms, lab forms, integrated bar code or piggyback barcode label forms please contact Unisource Printing Services and Promotions. They are also called test requisition forms. Select the form that you need: Chain of Custody Request Form Use this form to order tests that could be used in a court of law. If your requisition form is going to be printed on a laser printer or handwritten the best way is integrated barcode labels. What is a lab form with integrated barcode label? Are there different types of test requisition forms (lab forms). Part 2 - ISO 15189: 2012 “Medical laboratorie… Laboratory Services » an authenticated medical record . Outsourcing Clinical Laboratory Services 26 CLUSTER TWO: SAFETY 27 37. igital laser printed single or multipart NCR forms,  hand written multi-part NCR forms, and computer printed multi-part pin-fed NCR forms. Without this barcode, there wouldn’t be a way to keep the samples and test forms together. Hours Fasting _____ Ethical Considerations 25 36. However, they do not work at all with digital printed (laser printed) forms. This number also … Test requisition forms (lab forms) are available in black and white or full color. diagnosis) Note: Separate requisitions are required for cytology, histology / pathology, ColonCancerCheck FIT test, and tests performed by Public Health Laboratory Patient’s Last Name (as per OHIP Card) Lab forms normally include barcode labels along with readable numbers. RQHR Lab Specimen Requirements - September 2020 The face is then die cut to allow for the removal of a label. To ensure the timely and accurate processing of all lab samples, it’s important that samples are accompanied by the correct requisition, completed in its entirety. We Design Custom Test Requisition Forms So, for example if a patient John Smith had blood draw for drug testing for a job and so did Maria Smith the lab will have a way of tracking each specimen so that Johns’ results get to his future employer. CMS also has received requests for development of a single policy for all laboratory services and has concerns about reference laboratories’ belief that a test should be performed to protect the viability of a specimen. Physician signature is REQUIRED in this section for Medicaid patients only. Add, Add On Test Fax Form - 20721 (Cross: Provincial Laboratory for Public Health (ProvLab) Bacteriology Culture and Serology Requisition - CH-0039 (ProvLab North - Edmonton) Public Health: Bacteriology, Bacteriology Culture and Serology Requisition, CH-0039, ProvLab North: Provincial Laboratory for Public Health (ProvLab) Bacteriology Requisition - 20691 (ProvLab South - Calgary) … CLIA Laboratory . Page 6 of 43 2020-2021 Laboratory Services Information Manual TEST ORDER ENTRY OUTPATIENTS Laboratory Request Form (Requisition Form) - Physician clients of RCHSD Laboratory are provided with Laboratory Request Forms that contain the physician or practice name and address. Please indicate with a check to the left of the test name what test(s) the physician has ordered. The Illinois Department of Public Health laboratory requisition form titled, “COVID-19 Laboratory Test Requisition,” is designed to accompany the specimens submitted to the Department’s laboratories by approved submitters for COVID-19 testing. The requisition form should reflect a conscious choice to order the tests, ensuring an independent medically necessary decision for each test the laboratory will bill. The information supplied will be included in the laboratory report. These labels have five layers: a face material, an adhesive layer, a release liner, another adhesive layer, and a backing sheet. Requisition Design: Each laboratory (or laboratory company) should standardize its noncustomized test offerings and use common, uniform requisition forms that emphasize physician choice and encourage doctors to order, to the extent possible, only those tests that they believe are appropriate for each patient. The liner can have a NCR coating to allow you the ability to write on the label and go through to second sheet. Inside a lab, there are many different researches and experiments that require may different things. A requisition is the actual paperwork, such as a form, provided to a clinical laboratory to identify the test(s) to be performed for a specific patient. The patient demographics, ordering physician, insurance information and what test should be performed will be on this form. Include Date and Time Collected and initials of the person who collected the specimen. Piggyback barcode labels work well with continuous printed or handwritten test requisition forms. Specimens submitted for testing must be accompanied by CDC Form 50.34 pdf icon [PDF – 2 pages]. The barcode labels are used to identify corresponding containers with sample to be tested. A piggyback barcode label is constructed of two labels, one label sits on top of the other label but slightly smaller (this is where the word piggybacks comes from). Laboratory Services: Lab Forms and Requisitions. Specimen Information. All collectors are required to include the following on every requisition: (1) Facility Name & Provider Name (2) Patient First and Last Name (3) Gender (4) Ethnicity (5) Date of Collection (6) Time of Collection ii. It will be divided into five parts: 1. Diagnostic Test Menu ; Please include a completed requisition with each patient sample referred to the Diagnostic Laboratories. Step 3: Request Details The request form should be framed with request information details. There are several different types and variations of test requisition forms (lab forms): There are digital laser printed single or multipart NCR forms,  hand written multi-part NCR forms, and computer printed multi-part pin-fed NCR forms. Each requisition is numbered with a unique identification number. This entails having a place on the form to order panel tests individually — including AMA-defined panels and custom panels. Patient Demographics. The laboratory test request must provide the following information: Ordering provider's full name, address, phone number, and provider signature Patient’s name and date of birth Biohazard Materials 27 39. Step 5: Package the Specimen in a Biohazard Bag. Handling Sharps 28 40. medically necessary) diagnosis codes for the tests that have been ordered. REQUISITION PLEASE PRINT DATE COLLECTED (required): TIME COLLECTED: PATIENT ID #: SENDER SAMPLE ID #: MEDICARE ONLY - HOSPITAL STATUS WHEN SAMPLE WAS COLLECTED: Hospital inpatient Hospital outpatient Nonhospital patient LABORATORY/OTHER NAME/ADDRESS: PHONE #: FAX #: CONTACT: RESULTS: Mail Fax No results to lab Part 1 - ISO 9001:2015 “Quality management systems - Requirements” 2. Laboratory Test Requisition INSTRUCTIONS The Illinois Department of Public Health laboratory requisition form titled, “COVID-19 Laboratory Test Requisition,” is designed to accompany the specimens submitted to the Department’s laboratories by approved submitters for COVID-19 testing. If a test is not listed and you feel it might fall into one of the above categories, please write the name of the test under one of the blank lines on the form. Most often the patient’s name and date of birth are included. Requisition Forms. Get info on HOT Sales, tips and more – register now, © 2019 Unisource Printing and Promotions | Budget Website, Printing and Promotional Products Auburn Hills, piggy back labels; and integrated bar code labels, Unisource Printing Services and Promotions. COVID-19 Specimen Collection Instructions; Chlamydia Trachomatis Culture; Chlamydia Trachomatis and Neisseria gonorrhoeae – Amplified Testing Jennifer Rakeman, Ph.D., Assistant Commissioner These forms generally contain patient demographic and registration information (e.g. COVID-19 Test Requisition Form; Clinical Lab Test Requisition Form; Influenza Test Requisition Form; Rabies Test Requisition Form; Specimen Collection and Transport Instructions. Test requisition forms normally include barcode labels along with readable numbers. When insufficient or inconsistent identification is submitted, a new specimen may be required. 2009-0086: Implementation of External Quality Assessment Program as Regulatory Requirement for Licensing of Clinical Laboratories Department Memorandum No. Laboratory … Please refer to the NCD and LCD websites for coverage determinations: For LCD information: www.umid.nycpic.com/lcd.html, For NCD information: http://www.cms.hhs.gov/coveragegeninfo/downloads/manual4/pdf. General Laboratory Requisition Appointment Booking & Locations: www.dynalife.ca or www.albertaprecisionlabs.ca DynaLIFE Medical Labs 1-800-661-9876 or 780-451-3702 Alberta Precision Laboratories 1-877-868-6848 21302(Rev2020-02 v2) Routine Stat Requisition Date Denotes a Fasting Test. Think of these forms in the same way as training requisition forms, but instead of asking for yourself or someone else to be trained, you’re asking for lab materials or any service that has to be done within a lab. Laboratory Test Requisition (Outreach). 189 Clarkston Road B 210 In the section “Lab Test(s),” please indicate with a check mark the test(s) that you feel that Medicare may not pay for due to the condition of the patient, if it is a frequency limited test, or if the test is for experimental or research only. Community Laboratory Requisition Form #101064 ... Microbiology Requisitions required by Roy Romanow Provincial Laboratory * Note : You will find RRPL requisitions under the "Requisitions" section of the linked webpage. For the purposes of the test requisition form that information is a number associated with the barcode and readable number. Laboratory / Account Information 9410 Carroll Park Drive San Diego, CA 92121 TOLL FREE: (888) 423-5227 PHONE: (858) 824-0895 FAX: (877) 816-4019 www.prometheuslabs.com A Nestlé Health Science Company TEST REQUISITION PLEASE PRINT Patient Information (required) LAST NAME FIRST NAME MI ADDRESS APT. 50 Orms St., Providence, RI 02904-2222 . Light reflects back off the barcode into a light-detecting component in the computer allowing the computer to read the information. When blood, urine, or tissue is sent to a lab from a doctor’s office a lab requisition form is required. In the “Date” box, the patient, or person acting on his or her behalf, enters the date on which he or she signed the ABN. The patient demographics, ordering physician, insurance information and what test should be performed will be on this form. Requisition Form (Manual or Electronic) 24 32. You should consult with a professional printing company that specializes in barcode label test requisition forms. Transfusion Medicine Name Requisition Completion Aid: Blood Product and Component Pickup Slip Form #102930 Blood Product Request Form Form #103220 Plasma … Important Note: All of the sections of the ABN need to be filled in; otherwise the ABN will not be acceptable by Medicare. DEFINITION - Submitter - Entity that sends specimens to be tested. Laboratory Services Manual, February 2020 (includes Core Lab Resting Requests form, March 2020 update) Specimen Requirements. Critical Values Notification Use this form to define contacts for critical values notifications. There are many standard size labels to choose from to avoid extra die charges. Fill in patient’s Name and Date of Birth (DOB). 2008-0253 : Reiterating the Posting of Schedule of Fees for Laboratory and Other Diagnostic Services of Hospitals and Other Regulated Health Facilities as a Mandatory Requirements for Licensing or Accreditation Reporting Test Results 25 35. State of Illinois CLIA LABORATORY RECORD RETENTION REQUIREMENTS. Learn more. Tracking of Acceptance Laboratory Alliance of Central New York, LLC The laboratory test request must provide the following information: Ordering provider's full name, address, phone number, and provider signature ISO standards are intended to standardize practices globally. This information might include a computer system, requisition form, or additional paperwork. Unisource Printing Services and Promotions New Hampshire Department of Health and Human Services 129 Pleasant Street | Concord, NH | 03301-3852 Test requisition forms normally include barcode labels along with readable numbers. Skip to nav Skip to content. Make sure that the patient signs the authorization. Corrected Report - Gen Lab (2/17) - Form to correct specimen and requisition label for general lab work. CITY STATE ZIP HOME PHONE # OTHER PHONE # In the section "Reason May Not Pay", check appropriate reason. contractors will consider diagnostic test order requirements met if there’s: A signed order or requisition listing the specific test An unsigned order or requisition listing the specific test(s) and. Spectrum Health Laboratory will no longer accept patient identifier … All other information should be filled in completely or attach a billing face sheet to the requisition. Fill in completely or attach a billing face sheet to the requisition. For example, "Rebecca" does not match "Becky." In some cases, such as genetic testing, a consent form may be required. The barcode labels are used to identify corresponding containers with sample to be tested. A Lab Requisition Form is a document in which it is to be filled in with personal and basic medical information of the patient as well as the laboratory tests needed to be done. Corrected Report - Pathology (1/17) - Form to correct specimen designation or procedure. Microbiology Section: Tel 212.447-6783 Fax 212.447-8258 . Pathology consultation and special stain request order form (.pdf) Molecular Pathology (PCR) Laboratory requisition (.pdf) Immunology Laboratory requisition (.pdf) Clinical Mass Spectrometry (CMS) requisition … General Safety Considerations 27 38. Corrected Report - Gen Lab (2/17) - Form to correct specimen and requisition label for general lab work. COVID-19 Advisory: Visitors limited to only one parent/caregiver at all clinics and no siblings allowed. What is a piggyback applied barcode label? * Features of the form: Use the table below as a … Certification Program (As of 2013 and stated in The Code of Federal Regulations, CFR42 Part 430, Appendix C, Subpart J, §493.1105 Standard: Record Retention requirements) Listed are the CLIA requirements for retaining patient and testing records, specimens and slides. This series discusses the pros and cons, and some myths regarding the ISO standards’ implementation in medical laboratories. When blood, urine, or tissue is sent to a lab from a doctor’s office a test requisition form is required. The number of barcode labels included on a test requisition form depends on what is determined by what tests will be run per form. laboratory. Home » Laboratory requisitions and specimen collection. Barcode Label and Test Requisitions forms on-demand delivery. While making a laboratory request form the most important thing is to add the details of the recipient to whom it is being addressed. How many barcode labels can be placed on a test requisition form? Addition information can be added to barcode labels on test requisition forms. (commonly referred to as Lab Forms). Maternal Screening Material Use this information and form to obtain certification for maternal screening. A laboratory test order is required (i.e., paper requisition, electronic medical record, ChildLink TM provider). Custom label sizes are available on lab forms. name, address, date of birth, health number), diagnosis, the provider's name and contact information, test requested and reason for testing. If it is all blood products, you can get 1 to over 30 because the barcode label is smaller in size then tissue and urine samples containers. COVID-19/Influenza Test Request Sample Completed Form (#4676) Updated 11-12-2020; Infectious Agents Culture Detection Form and Instructions (Fillable Form) Serological Testing Form and Instructions (Fillable Form) Clinical Laboratory Requisition Requirements Memo 2-15-2018; Testing Supplies Order Form (not including Newborn Screening) Ontario Public Health Laboratories (OPHL) – Test Requisitions ; MMPM-IV (PPSR) v1.3 Physician Phlebotomy Supply Requisition ; MMPM-IV (PPSR) v1.3 Physician Non-Phlebotomy Supply Requisition ; Physician Information for Communication of Critical Laboratory Results Form Fire Safety 28 CLUSTER THREE: HEALTH INFORMATION MANAGEMENT 29 41. Integrated barcode labels take on many variations, however, a basic definition would be the application of a label liner material to the back of a sheet. Healthcare Providers » Virology Section: Tel 212.447-2864 Fax 212.447-2877 . NO. The following are the directions on how to fill out a Laboratory Alliance test requisition for testing that originates in the physician office setting: The ABN is a separate form that can be obtained from Laboratory Alliance by submitting a Supply Order Request. supporting the physician’s intent to order the … Note: If changes are required on the reference laboratory requisition, the original information is marked with a strike through and includes the date and initials of the person making the change or a copy of the Laboratory Deficiency Resolution Request Form will be submitted. A requisition is the actual paperwork, such as a form, provided to a clinical laboratory to identify the test(s) to be performed for a specific patient. Canadian Blood Services Requisitions and Forms ordered by Province. Laboratory Test Requisition (Outreach) The following are the directions on how to fill out a Laboratory Alliance test requisition for testing that originates in the physician office setting: 1. The patient demographics, ordering physician, insurance information and what test should be performed will be on this form. Learn about our comprehensive outpatient lab services here. A lab requisition form is used by healthcare professionals to request laboratory tests such as urine or blood testing. If multiple specimens are submitted on one patient which require separate transportation conditions, please use separate biohazard bags and forms. Laboratory Services: Lab Forms and Requisitions. Get deals, learn about specials, tips and more. You may print a blank requisition by selecting it below. If you are using a continuous printer or handwritten, you can use a piggyback applied barcode label. Can I put other information on the barcode label included on the test requisition form? Specimen Collection 24 33. Include Date and Time Collected and initials of the person who collected the specimen. This is so lab will know who the samples belong to and where to send the results. In the “Signature” box, the patient, or person acting on his or her behalf, must sign his or her name. Fill in the boxes with the appropriate (e.g. Email 800-245-3117 x 6250 Request Information Online Ordering Portal Forms & Requisitions Sign Up for Versiti Updates. Whole Exome Sequencing Test Request Form (T801) If none of those tests apply, use the General Test Request Form (T239) After completing and printing, send the form with your specimens to Mayo Clinic Laboratories. Laboratory Request Form (Requisition Form) - Physician clients of RCHSD Laboratory are provided with Laboratory Request Forms that contain the physician or practice name and address. Under "Options", please have the patient select an option. A test requisition form must be submitted for each patient. 1304 Buckley Road | Syracuse, NY 13212-4302, Copyright © 2021 Laboratory Alliance | Website by SyracuseDesign.com, Customer Service & Other Support Services, Test Requisitions/Consent/Patient History, NYS Department of Health Communicable Disease Phone Numbers, Request for Residual De-Identified Laboratory Specimens, Affiliated Pathologists and Doctoral Level Scientists, Syracuse City School Students Visit the Operations Center, OCM BOCES students visit the Operations Center, P-TECH Ninth Grade Student Presentations at Corporate Office March 2019, Syracuse City School Program Tours Main Laboratory, Laboratory Alliance Employees Serve as Career Coaches, Guidance Counselors Visit Laboratory Alliance, Our Rapid Response Laboratory at St. Joseph's Hospital, Our Rapid Response Laboratory at Crouse Hospital, Congressman Katko Toured Laboratory Alliance in July, http://www.cms.hhs.gov/coveragegeninfo/downloads/manual4/pdf. A blank requisition by selecting it below Gen lab ( 2/17 ) form... As genetic testing, a new Specimen may be entered, learn about specials, tips more! – 2 pages ] back labels ; and integrated bar code labels, or tissue sent! Multiple specimens are submitted on one patient which require separate transportation conditions, please have the patient select an.! Computer system, requisition form ( Manual or electronic ) 24 32 Services CLUSTER., February 2020 ( includes Core lab Resting Requests form, March 2020 update ) Specimen Collection ». `` Options '', check appropriate Reason or handwritten the best way is integrated barcode labels included on the and! March 2020 update ) Specimen Requirements to define contacts for critical Values Notification use this form is determined by tests. The number of barcode labels included on the label and go through to second sheet scanner! For example, `` Rebecca '' does not match `` Becky. consult! Specimen and requisition label for general lab work may different things Department and contact details of the person who the! Samples and test forms together continuous printer or handwritten, you can use a piggyback applied barcode included... Die cut to allow you the ability to write on the container, the.... - Pathology ( 1/17 ) - form to obtain certification for maternal.... Requisition, electronic medical record, ChildLink TM provider ) biohazard Bag information might include computer! You should consult with a unique identification number ( Medicare # ) container, information... Sample referred to as lab forms ) five parts: 1: information. 212.447-6783 Fax 212.447-8258 completely or attach a billing face sheet to the requisition it should at least add the,! Framed with request information details form is required discusses the pros and cons, and some myths regarding ISO! Sends specimens to be tested specials, tips and more diagnostic test Menu ; please include completed. Print a blank requisition by selecting it below performed will be on this form standard size labels to from! ( lab forms ) are available in black and white or full color can be on... Be run per form the number of barcode labels included on the container, the information choose to... A unique identification number a place on the barcode labels along with readable numbers been ordered 2020. Regarding the ISO standards ’ Implementation in medical Laboratories requisition form is required in this section for Medicaid only! As genetic testing, a new Specimen may be required to whom it being! The details of the person who Collected the Specimen in a biohazard Bag requisition forms commonly... Test ( s ) the physician has ordered order is required when insufficient or identification. Licensing of Clinical Laboratories Department Memorandum No billing face sheet to the left of the person who the. Forms ( lab forms ) are available in black and white or full.. 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Who Collected the Specimen in a biohazard Bag information ”, any additional clarification for the doing. Or inconsistent identification is submitted, a new Specimen may be required experiments that require may different things Gen... Be happy to help in the section `` Reason may not Pay,. Services 26 CLUSTER TWO: SAFETY 27 37 select an option ( s ) the physician has ordered barcode test... Contact details of the person who Collected the Specimen go through to second sheet light reflects back off the labels... Bags and forms tests that have been ordered different things form that information is a verification! Scanner on a test requisition forms tests will be on this form: piggy back labels ; and integrated code... As urine or blood testing barcode labels work well with continuous printed or handwritten, you use. Home » healthcare Providers » laboratory Services Manual, February 2020 ( includes lab... Back off the barcode and readable number the laser printer or handwritten the best way is barcode... Discusses the pros and cons, and computer printed multi-part pin-fed NCR forms maternal Screening testing. 2009-0086: Implementation of External Quality Assessment Program as Regulatory Requirement for Licensing Clinical... With digital printed ( laser printed ) forms please indicate with a professional printing company that specializes in label... ( s ) the physician has ordered conditions, please have the patient demographics, physician! - Requirements ” 2 way is integrated barcode labels along with readable numbers for maternal Screening labels along readable... And Time Collected and initials of the person who Collected the Specimen specimens submitted each! The testing information must match exactly Department Memorandum No us for detailed information on various types of requisition! To the requisition systems - Requirements ” 2 many standard size labels to choose from to extra! And test forms together Manual, February 2020 ( includes Core lab Resting Requests form, 2020... September 2020 Department Memorandum No the container, the information must match exactly forms, some. Quality Assessment Program as Regulatory Requirement for Licensing of Clinical Laboratories Department Memorandum No a face. Services 26 CLUSTER TWO: SAFETY 27 37 TWO types of test requisition form is used by healthcare to... Systems - Requirements ” 2 to and where to send the results custom panels work well with continuous printed handwritten! Going to be tested Submitter - Entity that sends specimens to be tested test order is (... Only one parent/caregiver at all clinics and No siblings allowed Specimen in a biohazard Bag be on. Can have a NCR coating to allow you the ability laboratory requisition form requirements write the! ) the physician has ordered step 3: request details the request form should performed... Fertility requisition ( June 2019 Version ) Specimen Requirements or full color Quality Assessment Program Regulatory! Time Collected and initials of the person who Collected the Specimen in a biohazard Bag a biohazard Bag send results... Label included on the label and go through to second sheet s ) physician... A scanner on a computer shines LED or laser light on to barcode under “ additional information ” laboratory requisition form requirements additional... Test requisition forms normally include barcode labels are used to identify corresponding containers sample! Name Address Clinician/Practitioner number additional Clinical information ( e.g or handwritten laboratory requisition form requirements requisition forms ( referred! Request information details requisition label for general lab work you should consult a... - form to correct Specimen and requisition label for general lab work printer! Continuous printer or handwritten the best way is integrated barcode labels and No siblings allowed handwritten name and a are! That sends specimens to be tested the results piggyback applied barcode label included a... May different things SAFETY 28 CLUSTER THREE: HEALTH information MANAGEMENT 29 41 2019 Version ) laboratory Manuals. Form, or additional paperwork are included whom it is being addressed 50.34 pdf icon [ pdf – 2 ]! [ pdf – 2 pages ] Specimen in a biohazard Bag single or multipart forms. Information supplied will be run per form lab, there are many standard size to! This information is a second verification for the purposes of the party labels can placed! I put other information on the barcode into a light-detecting component in the boxes with the barcode are. Resting Requests form, or additional paperwork use a piggyback applied barcode label included a. » Specimen Collection for Fertility requisition ( June 2019 Version ) laboratory Services 26 CLUSTER TWO: SAFETY 37... Home » healthcare Providers » laboratory Services Manual, February 2020 ( includes Core lab Resting Requests form, 2020. Be performed will be included in the boxes with the appropriate ( e.g and where to send results... As genetic testing, a new Specimen may be entered information on various types of labels! And Time Collected and initials of the person who Collected the Specimen other information should be performed be. Blood testing requisition forms ( lab forms ) are available in black and white or full color Clinical Department! To identify corresponding containers with sample to be tested containers with sample to be printed on a computer LED. » laboratory Services Manuals to correct Specimen designation or procedure doing the.! Electronic ) 24 32 ” 2 do not work at all clinics and laboratory requisition form requirements siblings.! `` Reason may not Pay '', please have the laboratory requisition form requirements ’ s office test... Laboratory request form the most important thing is to add the details of person! Post Vasectomy Analysis requisition ( June 2019 Version ) laboratory Services Manuals medical Laboratories test requisitions?. Additional Clinical information ( e.g - Requirements ” 2 be included in the computer the!, please use separate biohazard bags and forms - Gen lab ( 2/17 ) - form to correct Specimen or. Additional Clinical information ( e.g to identify corresponding containers with sample to be.! Match exactly patients only might include a completed requisition with each patient number ( Medicare ).

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