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Content Overview

The Order Quest Diagnostics form is a crucial document that facilitates the collection of essential patient information for laboratory testing. It captures various details, including the patient's name, date of birth, and sex, ensuring that the right tests are conducted for the right individual. The form requires information about the ordering physician, including their name and address, which helps maintain clear communication between the laboratory and healthcare providers. Patients are also asked to indicate their fasting status and whether they are pregnant, both of which can impact test results. Additionally, the form allows for the inclusion of insurance information, ensuring that billing is handled appropriately. Specific tests can be requested, ranging from basic biochemistry to comprehensive profiles, making it adaptable to various clinical needs. Patient contact details are collected for invoicing purposes, and there is space for clinical details that may guide the laboratory in interpreting results. With its structured layout, the Order Quest Diagnostics form simplifies the process of obtaining critical health information while ensuring that all necessary protocols are followed.

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Surname:

Quest Diagnostics

10 Upper Wimpole Street

London, W1G 6LL

Account Code:

provided by Quest Diagnostics

Ordering Physician:

Forenames:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

 

 

 

 

Sex:

 

 

 

 

 

 

 

day

month

year

 

 

 

Male

Female

Ethnic Origin:

 

Office / Patient number:

 

Fasting:

 

Pregnant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Physician:

Send duplicate report copy to:

Physician's Address: Required if no account code indicated

Address Line # 1

Patient's title:

Mr / Mrs / Dr / Prof / etc

Date collected:

day month year

Time collected: (24 hour clock)

hour minute

Fees to be paid by:

 

 

Doctor

Patient

 

Insurance Company

Other

 

 

details below

INSURANCE REFERENCE

Address Line # 2

Address Line # 3

Address Line # 4

Reports by:

Telephone: code number

Facsimile: code number

Patient Address: only required if patient is receiving invoice

Address Line # 1

Address Line # 2

Address Line # 3

Address Line # 4

Clinical Details:

Short Biochemistry

(QDL1)

Comprehensive Profile

(QDL5)

Lipid Profile

(QDL9)

SST

 

SST, Lavender, ESR

 

SST

 

Full Biochemistry

 

 

 

(QDL2)

Haematology Profile

(QDL6)

Hepatic Profile

(QDL10)

SST

 

 

 

 

 

 

Short Biochemistry

 

Lavender, ESR

 

SST

 

 

 

 

 

 

plus Haematology

(QDL3)

Thyroid Profile 1

(QDL7)

Immunology Profile

(QDL11)

SST, Lavender, ESR

 

SST

 

ESR, Lavender, SST

 

 

 

 

 

Full Biochemistry

 

Thyroid Profile 2

(QDL8)

MSU Profile

(QDL12)

plus Haematology

 

(QDL4)

SST

 

Mid Stream Urine

 

SST, Lavender, ESR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRM.UWS.2401.H07.3

FBC

 

 

(Lav)

Coagulation

 

(Light Blue)

PT & APTT

 

 

 

ertert

 

 

 

U & E

 

 

(SST)

Cardiac Enzyme

 

 

(SST)

Autoantibodies

 

 

(SST)

PSA

 

 

(SST)

PSA, free PSA ratio

 

(SST)

HIV screen

 

 

(SST)

Hepatitis B surface Ag

(SST)

Hepatitis B immunity

 

(SST)

ThinPrep

(ThinPrep Vial)

Pap smear

 

 

(Slide)

 

 

 

 

Other Tests:

Sample Type:

Source:

 

 

 

 

 

 

 

 

 

 

Reason for Smear:

 

 

 

LMP (1st DAY):

 

LAST TEST:

 

 

Pregnant: Y / N

IUCD Fitted: Y / N

Post Natal: Y / N

Taking Hormones: Y / N

 

 

 

 

 

 

 

 

 

 

Office use only - do not write here

 

 

 

 

 

 

 

 

70002 RF02050/1

FOR LAB USE ONLY

 

 

RECEIPT OF SPECIMEN

 

OTHERS

 

 

 

 

 

 

 

 

EDTA

SST

GREY

MSU

TIME IN (R)

TIME IN PHL

TIME OUT PHL

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Specifications

Fact Name Description
Ordering Physician Details The form requires the name of the ordering physician, including their forenames and title, ensuring proper identification for the test request.
Patient Information Essential patient details such as surname, date of birth, sex, and ethnic origin must be provided to accurately process the test results.
Insurance Information The form includes sections for insurance reference and payment responsibility, allowing for clear billing processes and potential coverage verification.
Governing Law For state-specific forms, compliance with local health regulations and privacy laws, such as HIPAA, is required to protect patient information.

Order Quest Diagnostics: Usage Guidelines

To complete the Order Quest Diagnostics form, gather the necessary information beforehand. This will ensure a smooth process. Once you have everything ready, follow the steps below to fill out the form accurately.

  1. Enter your Surname and Forenames in the designated fields.
  2. Provide your Date of Birth in the format: day, month, year.
  3. Select your Sex by checking either Male or Female.
  4. Indicate your Ethnic Origin if required.
  5. Fill in the Office / Patient number if applicable.
  6. Specify if you are Fasting and if you are Pregnant.
  7. If there is an Additional Physician, provide their name.
  8. Fill out the Physician's Address if no account code is indicated.
  9. Choose your Patient's title (Mr, Mrs, Dr, Prof, etc.).
  10. Enter the Date collected and Time collected in 24-hour format.
  11. Indicate who will pay the fees: Doctor, Patient, Insurance Company, or Other.
  12. If using insurance, provide the INSURANCE REFERENCE.
  13. Fill in the Patient Address only if the patient is receiving an invoice.
  14. Provide Clinical Details by selecting the relevant tests from the list.
  15. For Other Tests, specify the Sample Type, Source, and Reason for Smear.
  16. If applicable, enter the LMP (1st DAY) and LAST TEST.
  17. Indicate if you are Pregnant, if an IUCD is fitted, if you are post-natal, and if you are taking hormones.

After filling out the form, review all entries for accuracy. Ensure that any additional details are provided as needed. Once confirmed, submit the form as instructed by Quest Diagnostics.

Your Questions, Answered

What is the purpose of the Order Quest Diagnostics form?

The Order Quest Diagnostics form is used to request various laboratory tests for patients. Physicians fill out this form to specify the tests needed, gather patient information, and ensure that the laboratory has all necessary details to process the samples accurately. This form helps streamline the testing process and facilitates communication between healthcare providers and the laboratory.

What information is required on the form?

The form requires several key pieces of information, including the patient's surname, date of birth, sex, and ethnic origin. Additionally, it asks for the ordering physician's details, the patient's address, and specific clinical details about the tests requested. Information regarding insurance, payment responsibility, and any duplicate report requests is also included to ensure proper billing and communication.

How should I fill out the patient's details?

What types of tests can be ordered using this form?

The form allows for a variety of tests, including but not limited to biochemistry profiles, lipid profiles, hematology profiles, and thyroid profiles. Specific tests like HIV screening, hepatitis B testing, and PSA tests can also be ordered. Each test type is categorized to help physicians select the appropriate tests based on clinical needs.

What should I do if I don’t have an account code?

If you do not have an account code, it is essential to provide the physician's address on the form. This information is required to ensure proper billing and communication regarding the test results. Without an account code, the laboratory may not process the order, so it is important to complete this section thoroughly.

Is fasting required before certain tests?

Yes, some tests require fasting to ensure accurate results. The form includes a section where you can indicate whether the patient has fasted. It is important to follow any fasting instructions provided by the physician or laboratory to avoid any potential inaccuracies in test results.

What if the patient is pregnant?

If the patient is pregnant, this should be indicated on the form. Certain tests may have different implications or requirements for pregnant individuals. By noting this information, the laboratory can take appropriate measures when processing samples and interpreting results.

Can I request a duplicate report?

Yes, you can request a duplicate report by specifying the additional physician's details on the form. This is particularly useful if multiple healthcare providers need access to the same test results. Ensure that the duplicate report request is clearly indicated to avoid any confusion during processing.

How will I receive the test results?

Test results are typically sent to the ordering physician's address or via fax as specified on the form. If the patient is responsible for payment, the results may also be sent directly to the patient’s address. Ensure that the correct contact information is provided to facilitate timely delivery of results.

What should I do if I need to make changes to the form after submission?

If changes are necessary after the form has been submitted, contact the laboratory directly. Provide them with the updated information and any relevant details to ensure that the correct tests are performed and results are accurately reported. Prompt communication can help resolve any issues that may arise.

Common mistakes

  1. Incomplete Personal Information: Failing to fill out all required fields such as surname, date of birth, and sex can lead to processing delays.

  2. Incorrect Account Code: Not providing the correct account code or leaving it blank can hinder billing and insurance claims.

  3. Missing Ordering Physician Details: Omitting the name of the ordering physician can create confusion and affect the validity of the order.

  4. Ignoring Fasting Requirements: Not indicating fasting status when required may result in inaccurate test results.

  5. Neglecting to Specify Insurance Information: Failing to provide insurance details can complicate payment processes and lead to unexpected charges.

  6. Incorrect Patient Address: Providing an incorrect or incomplete patient address can prevent the timely delivery of test results.

  7. Not Indicating Pregnancy Status: Overlooking the pregnancy question can affect the interpretation of certain test results.

  8. Choosing the Wrong Tests: Selecting inappropriate tests or failing to clarify the clinical details may lead to irrelevant results.

  9. Forgetting to Sign the Form: Not signing the form where required can render the order invalid and delay processing.

Documents used along the form

The Order Quest Diagnostics form is a vital document used for requesting laboratory tests. Alongside this form, several other documents and forms are commonly utilized to ensure a smooth process in patient care and laboratory operations. Here’s a brief overview of these related documents:

  • Patient Registration Form: This form collects essential information about the patient, including personal details, insurance information, and medical history. It is typically completed during the first visit to a healthcare provider.
  • Insurance Verification Form: This document is used to confirm the patient's insurance coverage and benefits. It helps healthcare providers understand what services are covered and what the patient may need to pay out-of-pocket.
  • Informed Consent Form: Patients sign this form to acknowledge that they understand the procedures and risks associated with the tests being performed. It ensures that patients are fully informed before undergoing any laboratory tests.
  • Test Result Report: After the laboratory processes the samples, this report provides detailed results of the tests performed. It is typically sent to the ordering physician and may also be provided to the patient, depending on the circumstances.
  • Referral Form: If a patient needs to see a specialist for further evaluation or treatment based on test results, this form is used to refer them. It includes details about the patient's condition and the reason for the referral.

These documents work together to facilitate effective communication between patients, healthcare providers, and laboratories. Properly managing these forms can enhance patient care and streamline laboratory processes.

Similar forms

  • Patient Registration Form: Similar to the Order Quest Diagnostics form, a patient registration form collects essential patient information, including name, date of birth, and contact details. Both documents serve to establish a patient's identity and facilitate medical record-keeping.

  • Insurance Claim Form: This document is used to submit claims to insurance companies for reimbursement. Like the Order Quest Diagnostics form, it requires detailed information about the patient, the services provided, and billing details, ensuring that all necessary information is available for processing claims.

  • Laboratory Requisition Form: A laboratory requisition form is used to request specific tests from a lab. Similar to the Order Quest Diagnostics form, it includes patient demographics, the ordering physician's information, and details about the tests required, facilitating efficient communication between healthcare providers and laboratories.

  • Consent Form: A consent form is used to obtain patient permission for medical procedures or tests. Like the Order Quest Diagnostics form, it emphasizes the importance of informed consent, ensuring that patients understand what tests they are undergoing and any associated risks.

Dos and Don'ts

When filling out the Order Quest Diagnostics form, it is important to follow certain guidelines to ensure accuracy and clarity. Here is a list of things to do and not to do:

  • Do use clear handwriting or type the information to avoid misinterpretation.
  • Do include all required personal information, such as your surname, date of birth, and sex.
  • Do provide an account code if you have one. This helps streamline the process.
  • Do specify the ordering physician's name and address to ensure proper communication.
  • Do indicate if you are fasting or pregnant, as this can affect test results.
  • Don't leave any mandatory fields blank; this can delay processing.
  • Don't use abbreviations or shorthand that may not be universally understood.
  • Don't forget to check the insurance information if applicable, as this is crucial for billing.
  • Don't submit the form without reviewing all entries for accuracy.

Misconceptions

  • Misconception 1: The Order Quest Diagnostics form is only for specific tests.
  • This form is versatile and can be used for a wide range of tests, from biochemistry to immunology. It covers numerous profiles, ensuring that healthcare providers can order exactly what they need.

  • Misconception 2: You must fill out every section of the form.
  • While it's important to provide as much information as possible, not every section is mandatory. Focus on the critical details relevant to the patient's care.

  • Misconception 3: Only doctors can order tests using this form.
  • While physicians typically complete the form, other qualified healthcare professionals can also order tests. This allows for a more collaborative approach to patient care.

  • Misconception 4: Insurance information is optional.
  • Providing insurance details is crucial if the patient expects coverage for the tests. Without this information, the patient may face unexpected costs.

  • Misconception 5: Fasting is always required before testing.
  • Fasting is only necessary for certain tests. It's essential to check the specific requirements for each test to ensure accurate results.

  • Misconception 6: The form is only for adult patients.
  • The Order Quest Diagnostics form can be used for patients of all ages, including children. Just ensure that you provide the correct details for pediatric patients.

  • Misconception 7: You can submit the form without a physician's signature.
  • A physician's approval is generally required to validate the order. This helps ensure that tests are medically necessary and appropriate for the patient.

  • Misconception 8: Once submitted, you cannot make changes to the order.
  • While it's best to double-check the form before submission, if changes are needed, you can often contact the lab to amend the order. Communication is key in these situations.

Key takeaways

When filling out the Order Quest Diagnostics form, keep these key points in mind:

  • Accurate Information: Ensure all personal details, such as your name and date of birth, are filled out correctly to avoid any processing delays.
  • Account Code: If you have an account code from Quest Diagnostics, make sure to include it. This helps in streamlining the billing process.
  • Ordering Physician: Clearly indicate the name of the physician ordering the tests. This helps in associating the results with the right healthcare provider.
  • Patient Address: Fill in your address only if you expect to receive an invoice. This ensures that you get the necessary billing information.
  • Insurance Information: If applicable, provide your insurance details. This can facilitate coverage for the tests you are undergoing.
  • Fasting Requirements: Note if fasting is required before your tests. This is crucial for accurate results.
  • Sample Type: Specify the type of sample being collected, as this can affect the tests being performed.
  • Clinical Details: Include relevant clinical details or specific tests requested. This ensures the laboratory knows exactly what to analyze.
  • Contact Information: Provide a phone number for any follow-up questions or clarifications regarding your tests.
  • Signature: Don’t forget to sign the form if required. This confirms that you authorize the tests and any related charges.

By keeping these takeaways in mind, you can help ensure a smoother experience with your Quest Diagnostics order.