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Free printable lab requisition form

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The document is a laboratory requisition form for Kaiser Permanente, requiring detailed patient information, test selections, and provider signatures. It outlines various laboratory tests available, including urinalysis, hematology, chemistry profiles, therapeutic drug monitoring, and special chemistry tests. The form emphasizes the need for accurate completion and submission via secure fax to facilitate routine laboratory testing.

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Versions	Form popularity	Fillable & printable
2016	4.6 Satisfied (21 Votes)
2008	4 Satisfied (31 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Do requisitions expire?

Yes, requisitions do not expire.

What is a requisition form in medical terms?

Requisition forms, sometimes called referral forms, are used by your doctor or local physician to communicate precisely what type of exam you require for a medical assessment. These forms direct our technologists by outlining where diagnostic imaging is needed, such as your left shoulder or right ankle.

What is requisition form for laboratory?

For laboratories, a lab requisition form is a written request for a medical test or procedure. It is written by a doctor or medical facility, and then fulfilled at the lab.

What should be included on a lab requisition form?

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. Test(s) requested. Diagnosis and/or ICD-10 Codes. Date and time of order.

What are the required information on a requisition form?

A requisition form, whether physical or digital, typically includes the details about the item(s) requested, the date of the request, the individual and department making the request and the location where the goods should be delivered.

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What information is required on lab requisitions quizlet?

Laboratory requisitions must include doctor's name; patient's name, age, date of birth, and identification number; tests to be performed; and date and time for specimen collection.

What is the purpose of requisition form in phlebotomy?

A requisition form must accompany each sample submitted to the laboratory. This requisition form must contain the proper information in order to process the specimen. The essential elements of the requisition form are: Patient's surname, first name, and middle initial.

Why is a lab requisition important?

Every specimen entering your lab includes an often overlooked, but important piece of paper \u2013 the test requisition form. This form contains critical information about the patient, ordering physician, ordered tests, and insurance data.

What is the purpose of the laboratory requisition form?

What is a lab requisition form? A lab requisition form is used by healthcare professionals to request laboratory tests such as urine or blood testing. They are also called test requisition forms. When blood, urine, or tissue is sent to a lab from a doctor's office a lab requisition form is required.

How long is a lab requisition good for?

For patient safety, each Laboratory Requisition is only valid for 6 months after the date that it was authorized.

Get the up-to-date lab requisition form 2025 now

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The easiest way to edit Lab requisition form in PDF format online

See more lab requisition form versions

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Got questions?

Do requisitions expire?

What is a requisition form in medical terms?

What is requisition form for laboratory?

What should be included on a lab requisition form?

What are the required information on a requisition form?

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What information is required on lab requisitions quizlet?

What is the purpose of requisition form in phlebotomy?

Why is a lab requisition important?

What is the purpose of the laboratory requisition form?

How long is a lab requisition good for?

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