Blank Lab Requisition PDF Form

What is a Lab Requisition form?

A Lab Requisition form is a document used by healthcare providers to request specific laboratory tests for their patients. It includes essential information such as the patient's demographics, the tests being ordered, and the provider's details. This form ensures that the laboratory has all the necessary information to process the tests accurately and efficiently.

Who fills out the Lab Requisition form?

The Lab Requisition form is typically filled out by the healthcare provider who is ordering the tests. This could be a physician, nurse practitioner, or another qualified healthcare professional. They must provide accurate patient information, select the appropriate tests, and sign the form to validate the request.

What information is required on the Lab Requisition form?

Essential information on the Lab Requisition form includes the patient's name, date of birth, gender, and diagnosis codes. Additionally, the provider must include their name, contact information, and the specific tests being requested. Completing all fields is crucial to avoid delays in processing the tests.

How do I submit the Lab Requisition form?

Once completed, the Lab Requisition form should be faxed to the designated laboratory. For Kaiser Permanente, the secure fax number is 303-404-4030. It is important to ensure that the form is signed and dated before submission to validate the request.

What types of tests can be ordered using the Lab Requisition form?

The Lab Requisition form allows for a variety of tests, including urinalysis, hematology, chemistry profiles, and therapeutic drug monitoring. Specific tests can be selected based on the patient's needs and the provider's assessment. A comprehensive list of available tests is usually included on the form.

What should I do if I have questions about the Lab Requisition form?

If you have questions regarding the Lab Requisition form or the tests being ordered, you can contact the Laboratory Client Services Department at 303-404-4050. They are available Monday through Friday from 8 AM to 6 PM to assist with any inquiries about specimen collection or tube types.

What happens if the Lab Requisition form is incomplete?

An incomplete Lab Requisition form may lead to delays in processing the tests. The laboratory may contact the provider for clarification or additional information, which could prolong the time it takes to receive results. To avoid this, double-check that all required fields are filled out accurately before submission.

Can I pick up supplies for tests at any location?

Yes, 24-hour urine test containers can be picked up at any Kaiser Permanente laboratory location. No appointment is necessary for routine laboratory testing at these facilities. However, it is essential to confirm the availability of supplies at your chosen location before visiting.

1. Leaving out the ICD 9 Diagnosis Code(s) can lead to delays in processing. This information is essential for insurance coverage and proper test interpretation.

2. Not providing complete patient information, such as the full name and date of birth, may result in misidentification or errors in test results.

3. Failing to indicate the gender of the patient can affect certain tests and their interpretations.

4. Omitting the provider's information, including the name and contact details, can hinder communication and follow-up regarding test results.

5. Not specifying the test urgency (e.g., STAT, ASAP, or routine) can lead to delays in receiving critical results.

6. Forgetting to sign and date the requisition form can render it invalid, causing the laboratory to reject the submission.

7. Neglecting to fill in the draw site and number of sticks can complicate the blood draw process and lead to additional patient discomfort.

The Lab Requisition form is an essential document used in the medical field to request laboratory tests for patients. However, it is often accompanied by other important forms and documents that help streamline the testing process and ensure accurate results. Below are some common forms that you might encounter alongside the Lab Requisition form.

• Patient Consent Form: This document is crucial as it ensures that the patient understands and agrees to the tests being performed. It typically includes information about the procedure, potential risks, and the purpose of the tests. Obtaining informed consent is a vital step in maintaining ethical standards in healthcare.
• Insurance Authorization Form: Before any tests are conducted, this form may be required to verify that the patient's insurance will cover the costs. It often includes details about the patient's insurance plan and specific tests being requested. This helps avoid unexpected expenses for the patient and ensures that the laboratory can proceed without financial barriers.
• Test Results Form: Once the laboratory completes the testing, the results are documented on this form. It provides detailed information about the findings and is typically sent to the requesting physician. This form is crucial for the physician to make informed decisions about the patient's treatment plan based on the test outcomes.
• Specimen Collection Instructions: This document outlines the proper procedures for collecting and handling specimens. It includes guidelines on how to collect samples, storage requirements, and transportation details. Following these instructions is essential for maintaining the integrity of the samples and ensuring accurate test results.

Each of these documents plays a significant role in the laboratory testing process. Together, they help ensure that patients receive the best possible care and that healthcare providers have the necessary information to make informed decisions. Understanding these forms can enhance communication and efficiency in medical settings.

The Lab Requisition form serves a vital role in the healthcare system, facilitating communication between healthcare providers and laboratories. Several other documents share similarities with the Lab Requisition form, each serving a unique purpose in the medical field. Here’s a list of ten documents that are comparable to the Lab Requisition form:

• Prescription Pad: Like the Lab Requisition, a prescription pad provides essential information about the patient and the required treatment or medication. Both documents require the provider's signature and date, ensuring proper authorization.
• Referral Form: This document is used to refer a patient to a specialist. Similar to the Lab Requisition, it includes patient information and the reason for the referral, facilitating continuity of care.
• Patient Intake Form: This form collects vital patient information, including medical history and current medications. It parallels the Lab Requisition in that both forms gather essential data to guide healthcare decisions.
• Insurance Claim Form: This document is submitted to insurance companies for reimbursement. Like the Lab Requisition, it requires detailed patient information and diagnosis codes to ensure proper processing.
• Medication Administration Record (MAR): The MAR tracks medications administered to patients. Both documents are crucial for ensuring accurate treatment and require clear documentation of patient details.
• Discharge Summary: This summary outlines a patient’s hospital stay and treatment. Similar to the Lab Requisition, it includes key patient information and serves as a communication tool between healthcare providers.
• Consent Form: A consent form is necessary for various medical procedures and treatments. Like the Lab Requisition, it must be signed by the patient or their representative, affirming their understanding and agreement.
• Advance Directive: This document outlines a patient's wishes regarding medical treatment. It shares similarities with the Lab Requisition in that both require clear communication of patient preferences to healthcare providers.
• Billing Statement: A billing statement details the services provided to a patient and the associated costs. Like the Lab Requisition, it contains important patient and provider information, ensuring transparency in healthcare transactions.
• Lab Test Results Report: This report communicates the findings of laboratory tests back to the healthcare provider. It parallels the Lab Requisition by summarizing essential patient information and test details for follow-up care.

Each of these documents plays a crucial role in the healthcare process, ensuring that patient care is coordinated, efficient, and effective. Understanding their similarities can enhance communication and streamline operations in medical settings.

When filling out a Lab Requisition form, attention to detail is crucial. Here are some essential dos and don'ts to ensure that the process goes smoothly.

• Do fill in all required fields completely, including the patient's name and date of birth.
• Do include the appropriate ICD 9 diagnosis codes to facilitate proper billing and testing.
• Do indicate the patient's sex clearly, as this may affect test results.
• Do specify any special instructions, such as fasting requirements or urgency of the tests (e.g., STAT or ASAP).
• Don't leave any sections blank, as incomplete forms may lead to delays in processing.
• Don't forget to sign and date the form, as this is a legal requirement for the requisition.
• Don't use abbreviations or shorthand that may confuse laboratory staff.
• Don't submit the form without verifying the laboratory location and fax number to ensure it reaches the correct facility.

Understanding the Lab Requisition form is essential for both healthcare providers and patients. However, several misconceptions often lead to confusion. Here are six common misconceptions explained:

• All information is optional on the form. Many believe that they can skip filling out certain sections. In reality, completing all required fields is crucial for processing and ensuring accurate results.
• Routine tests are covered by Medicare. Some assume that all tests are covered under Medicare. However, Medicare does not generally cover routine screening tests, which can lead to unexpected costs.
• Any healthcare provider can submit the requisition. It's a common belief that any provider can submit a requisition. In fact, only the attending physician or authorized personnel should sign and submit the form to ensure validity.
• Fasting is not necessary for all tests. Many think fasting is optional. However, specific tests require fasting to ensure accurate results, and this must be clearly indicated on the form.
• Specimens can be dropped off at any location. Some individuals believe they can drop off specimens at any Kaiser facility. This is incorrect; specimens must be submitted to designated locations only.
• The requisition form can be filled out post-visit. There is a misconception that the form can be completed after the patient visit. It is essential to fill out the form during the visit to ensure timely processing and diagnosis.

Clarifying these misconceptions can help streamline the testing process and improve patient care. Always consult with a healthcare professional if you have questions about the Lab Requisition form.

When filling out the Lab Requisition form, keep these key points in mind:

• Complete All Sections: Ensure that every part of the form is filled out, including provider information, patient details, and diagnosis codes.
• ICD Diagnosis Codes: Include the required ICD 9 diagnosis codes. Remember, Medicare typically does not cover routine screening tests.
• Patient Information: Clearly write the patient's name, date of birth, and gender. This helps in accurately identifying the patient.
• Test Selection: Choose the appropriate tests based on the patient's needs. Review the list of tests available and mark them clearly.
• Fasting Requirements: Indicate if the patient needs to fast before the tests. This can affect test results significantly.
• Signature and Date: The provider must sign and date the form. This confirms that the tests have been ordered by an authorized physician.
• Faxing the Form: Send the completed form to the designated fax number, ensuring it is sent securely.
• Draw Site Information: Specify the draw site and number of sticks required. If there are issues with drawing blood, note them on the form.
• Contact for Questions: If there are any uncertainties about the form or specimen collection, reach out to the Laboratory Client Services Department for assistance.

Following these steps will help ensure that the lab tests are processed smoothly and efficiently.