Lab Requisition Form – Fill Out and Use This PDF

Lab Requisition Form PDF Details

When a physician determines that a patient needs to undergo laboratory tests to diagnose or monitor a condition, a Lab Requisition form serves as the bridge connecting the healthcare provider's request and the laboratory's execution of these tests. This crucial document, filled out with meticulous attention to detail, specifies the patient's vital information, including name, date of birth, and sex, alongside the requesting physician's details such as name, address, phone number, and fax number. It also outlines the tests required, labeled under various categories like Urinalysis, Hematology, Coagulation, Chemistry Profiles, and more, each with specific tests enumerated for clarity. Special sections are devoted to Therapeutic Drug Monitoring and Special Chemistry, indicating the broad range of potential examinations for assessing patient health. Notably, the form underscores the necessity of including ICD 9 DIAGNOSIS CODE(s), reminding healthcare providers of Medicare's limitations regarding routine screening tests. Additionally, instructions regarding fasting, urgency of the tests (STAT, ASAP), and even special conditions like pregnancy testing or 24-hour urine tests highlight the form's comprehensive nature. The directive for specifying the time of the last dose for therapeutic drugs underlines the precision required in testing for accurate results. Furthermore, provisions for peak and trough measurements in Therapeutic Drug Monitoring reflect the attention to detail necessary for managing patient medication levels effectively. This form, serving both as an order for the lab and a record for the provider, ensures that all involved parties have the information needed to proceed with testing, thus playing a pivotal role in the patient's care continuum.