Lab Requisition Template

Lab Requisition: Usage Instruction

After completing the Lab Requisition form, the next step is to ensure that all the information is accurate and complete before sending it to the appropriate laboratory. This will help prevent any delays in processing the tests.

1. Fill in the UPIN / NPI# at the top of the form.
2. Enter the Provider Name in the designated space.
3. Provide the Address of the provider.
4. Write the Phone Number and Secure Fax Number.
5. Fill in the ICD 9 Diagnosis Code(s) as required.
6. Indicate the Gender of the patient by checking the appropriate box (MALE or FEMALE).
7. Enter the Date of Birth of the patient.
8. Write the Patient Name in the format of LAST, FIRST.
9. If applicable, include the Kaiser Medical Record #.
10. Select any necessary options such as NON-FASTING, STAT, ASAP, or FASTING HOURS.
11. Check the appropriate tests needed from the list provided.
12. Fill in the Date and Time of Last Dose for any therapeutic drugs, if applicable.
13. Provide any Comments as needed.
14. Sign and date the form as the provider.
15. Indicate the Draw Site and the Number of Sticks if necessary.
16. Check the box for Physician notified? with YES or NO.
17. Ensure all sections are complete before faxing the form to the laboratory.

1. What is a Lab Requisition Form?

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

2. What information is required on the form?

   To complete the Lab Requisition Form, providers must fill in several key details:

   • Provider's name and contact information
   • Patient's name and date of birth
   • ICD 9 diagnosis codes
   • Type of tests requested
   • Any special instructions, such as fasting requirements or urgency (STAT or ASAP)

   All sections must be filled out to ensure proper processing of the tests.

3. How do I submit the Lab Requisition Form?

   Providers should fax the completed and signed Lab Requisition Form to the designated laboratory fax number, which is 303-404-4030. It is crucial to ensure that the form is filled out completely and correctly before submission to avoid delays in testing.

4. What should I do if I have questions about the tests?

   If there are any questions regarding the tests or specimen collection, providers can call the Laboratory Client Services Department at 303-404-4050. They are available Monday through Friday from 8 AM to 6 PM and can provide guidance on tube types and other collection issues.

5. Are there any specific instructions for certain tests?

   Yes, some tests have specific requirements. For instance, certain tests may require fasting, while others may need to be drawn at specific times. It is essential to review the requisition form carefully and follow any special instructions provided to ensure accurate results. If in doubt, consult the laboratory or the attending physician for clarification.

Filling out a Lab Requisition form correctly is crucial for ensuring timely and accurate testing. One common mistake is leaving out the ICD 9 diagnosis code. This code is essential for the laboratory to understand the medical necessity of the tests. Without it, the laboratory may not process the requisition.

Another frequent error involves the patient’s information. Failing to provide the patient’s full name, including last and first names, can lead to confusion and misidentification. Always double-check that this section is complete and accurate.

People often neglect to indicate the gender of the patient. This detail is important for specific tests and can affect the interpretation of results. Marking the appropriate box for male or female ensures the laboratory has the necessary context for the tests being ordered.

Many individuals forget to specify the date of birth. This information is vital for age-related testing and ensures that the laboratory can accurately assess the results. Always include this detail to avoid unnecessary delays.

Another mistake is not indicating the type of test required. Whether it’s routine, fasting, or STAT, this information helps the laboratory prioritize and prepare for the tests accordingly. Be sure to select the correct option that applies to the situation.

Some people fail to provide a contact number for the provider. This can create problems if the laboratory needs to clarify any details regarding the requisition. Always include a phone number to facilitate communication.

It's also common to overlook the signature and date of the provider. Without these, the requisition may be considered incomplete. Ensure that the form is signed and dated to confirm that the tests have been authorized.

Lastly, failing to include specific comments or instructions can lead to misunderstandings. If there are particular concerns or additional information relevant to the tests, make sure to note them in the comments section. This helps the laboratory provide the best possible service.

The Lab Requisition form is a crucial document for ordering laboratory tests. However, it is often accompanied by other forms and documents that help streamline the testing process. Understanding these documents can make the process smoother for both patients and healthcare providers.

• Patient Consent Form: This form ensures that patients understand the tests being conducted and provide their consent. It protects both the patient and the healthcare provider by documenting the patient's agreement.
• Insurance Information Form: This document collects necessary insurance details from the patient. It helps verify coverage and ensures that the laboratory tests will be billed correctly.
• Test Preparation Instructions: These instructions inform patients about any preparations needed before the tests, such as fasting or avoiding certain medications. Clear guidance helps ensure accurate test results.
• Referral Form: If a patient is referred to a specialist, this form outlines the reason for the referral and any relevant medical history. It ensures that the laboratory has all necessary context for the tests.
• Specimen Collection Guidelines: This document provides detailed instructions on how to collect samples for testing. Following these guidelines is essential for obtaining reliable results.
• Results Report Form: After testing, this form is used to communicate the results to the healthcare provider. It includes important information about the findings and any necessary follow-up actions.

Having these documents in order can significantly enhance the efficiency of the testing process. Each form plays a vital role in ensuring that everything runs smoothly, from obtaining consent to delivering results. Being prepared can make a difference in patient care.

• Patient Registration Form: This document collects essential patient information, such as name, date of birth, and contact details. Similar to the Lab Requisition form, it ensures that the laboratory has accurate data to identify the patient and process tests efficiently.
• Referral Form: A referral form is used to direct patients to specialists or specific services. Like the Lab Requisition, it includes critical patient details and the referring provider's information, facilitating seamless communication between healthcare providers.
• Order Sheet: An order sheet outlines specific tests or procedures to be performed. It mirrors the Lab Requisition form in its purpose to convey instructions clearly to the laboratory, ensuring that the correct tests are conducted.
• Insurance Authorization Form: This document is necessary for obtaining approval from insurance companies for specific tests or treatments. Similar to the Lab Requisition, it includes patient and provider information and helps ensure that the necessary financial coverage is secured before testing.
• Test Results Report: A test results report provides outcomes from laboratory tests conducted. While it serves a different function, it shares similarities with the Lab Requisition form in that it contains patient identifiers and details about the tests performed, linking the patient to their medical history.
• Medication Administration Record (MAR): The MAR tracks medications administered to patients. Like the Lab Requisition, it includes patient demographics and is vital for maintaining accurate medical records, ensuring that all healthcare providers are informed about the patient’s treatment plan.

When filling out the Lab Requisition form, it is important to ensure that all information is accurate and complete. Here are some guidelines to help you navigate the process effectively:

• Do fill in all required fields, including provider name, address, and phone number.
• Don't leave any sections blank, especially the ICD 9 diagnosis code.
• Do indicate the patient's gender and date of birth clearly.
• Don't forget to specify if the test is fasting or non-fasting.
• Do sign and date the form before submitting it.
• Don't use abbreviations or shorthand that may confuse the lab staff.
• Do ensure the correct tests are selected based on the patient's needs.
• Don't submit the form without confirming that the physician has approved the tests.
• Do keep a copy of the requisition for your records.

By following these tips, you can help ensure a smooth process for lab testing. Accurate information leads to timely results, which is beneficial for patient care.

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

• All tests are covered by insurance. Many people believe that all laboratory tests are automatically covered by their insurance. In reality, insurance coverage varies, and some routine screening tests may not be covered, particularly under Medicare.
• Fasting is always required for tests. While some tests require fasting, not all do. The requisition form specifies whether fasting is necessary, so it’s crucial to read the instructions carefully.
• Any healthcare provider can fill out the form. It’s a common misconception that anyone can complete a lab requisition. Only licensed healthcare providers can sign and submit these forms, ensuring that the tests are medically justified.
• Lab results are available immediately. Many patients expect to receive lab results right away. However, processing times can vary based on the type of test, and some results may take several days to be reported.
• The form is the same for all labs. Different laboratories may have specific requisition forms tailored to their testing capabilities. Using the correct form ensures that the lab receives all necessary information for processing the tests.
• All specimens can be dropped off at any lab location. While Kaiser Permanente allows for routine testing without appointments, not all specimens can be accepted at every facility. It’s essential to verify where specific tests can be performed.
• There’s no need to provide additional information. Patients often think that filling out the basic information is sufficient. However, additional details, such as diagnosis codes and specific instructions, are crucial for accurate testing and billing.

By clarifying these misconceptions, patients and providers can ensure a smoother experience when utilizing laboratory services.

• Accurate completion of the Lab Requisition form is essential for proper patient care. Ensure all required fields are filled out, including the provider's name, address, and contact information.

• ICD 9 diagnosis codes must be provided. These codes are critical for insurance coverage and billing purposes, especially since Medicare does not cover routine screening tests.

• Specify the patient's gender and date of birth. This information is necessary for identification and accurate test results.

• Indicate the type of test required, such as fasting or non-fasting. This detail is important for the accuracy of certain tests.

• Fax the completed form to the designated number, 303-404-4030, to ensure timely processing of lab tests.

• Keep a record of the draw site and the number of attempts made to collect the specimen. This information can be important for follow-up and patient records.