Lab Requisition PDF Template

Instructions on Utilizing Lab Requisition

Filling out a Lab Requisition form is a straightforward process that ensures the necessary information is provided for lab tests. Completing this form accurately helps facilitate timely and effective patient care. Below are the steps to guide you through filling out the Lab Requisition form.

1. Provider Information: Enter the UPIN/NPI number, provider name, address, phone number, and secure fax number at the top of the form.
2. ICD Diagnosis Codes: Fill in the required ICD 9 diagnosis code(s) as applicable.
3. Patient Information: Indicate the patient's gender by checking either the "MALE" or "FEMALE" box. Then, provide the patient's date of birth.
4. Patient Name: Write the patient's full name in the format "LAST, FIRST." If applicable, include the Kaiser medical record number.
5. Test Information: Check the appropriate boxes for test urgency, such as "NON-FASTING," "STAT," "ASAP," or "FASTING HOURS." Also, indicate if the tests are "ROUTINE."
6. Select Tests: Choose the specific tests required by checking the corresponding boxes in the sections for Urinalysis, Hematology, Coagulation, Chemistry Profiles, Chemistry Single Tests, Therapeutic Drugs, Special Chemistry, Other Testing, and 24 Hour Urine Tests.
7. Draw Site: Specify the draw site and the number of sticks if applicable. Indicate if unable to draw and whether the physician has been notified.
8. Tube Type: Mark the types of tubes needed for the tests, such as SST, Lavender, Red, Blue, Green, Gray, Urine, Stool, or Swab.
9. Comments: Add any relevant comments in the comments section, if necessary.
10. Signature: The provider must sign and date the form to validate the requisition.

Once you have completed the form, it should be faxed to the designated number provided on the form. This will ensure that the laboratory receives the necessary information to process the tests efficiently.

What is a Lab Requisition Form?

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

Why is the Lab Requisition Form important?

The Lab Requisition Form is crucial for several reasons. First, it helps maintain clear communication between healthcare providers and laboratories. Second, it ensures that the correct tests are ordered based on the patient's medical needs. Finally, it helps streamline the testing process, reducing the chances of errors and delays in patient care.

What information do I need to provide on the Lab Requisition Form?

When filling out the Lab Requisition Form, you will need to provide information such as the patient's name, date of birth, gender, and diagnosis codes. Additionally, you must specify the tests you want to be performed and any special instructions, such as fasting requirements or urgency (e.g., STAT or ASAP).

How do I submit the Lab Requisition Form?

The completed Lab Requisition Form should be faxed to the designated laboratory number, which is 303-404-4030 in this case. Ensure that the form is signed and dated by the provider before submission. This step is essential to confirm that the tests have been approved by the attending physician.

What happens if I forget to include information on the Lab Requisition Form?

If critical information is missing from the Lab Requisition Form, it can lead to delays in testing or even incorrect tests being performed. It is vital to double-check all entries before submission. If you realize you've made an error after sending the form, contact the laboratory as soon as possible to rectify the situation.

Can I order any lab test using the Lab Requisition Form?

While many common tests can be ordered using the Lab Requisition Form, some specialized tests may require a phone call to the laboratory at 303-743-5330. Always check with the laboratory or your healthcare provider if you are unsure about the availability of a specific test.

What if I need a 24-hour urine test?

For a 24-hour urine test, you can pick up the necessary collection containers at any Kaiser Permanente laboratory location. No appointment is required for routine laboratory testing, making it convenient to obtain the containers and instructions for the test.

What should I do if I have questions about specimen collection?

If you have questions about specimen collection or tube types, you can reach out to the Laboratory Client Services Department at 303-404-4050. They are available Monday through Friday from 8 AM to 6 PM to assist you with any inquiries.

What if I need to reorder a Lab Requisition Form?

If you need to reorder a Lab Requisition Form, make sure to reference the reorder form number provided, which is 00254730. This will help the laboratory process your request more efficiently.

How do I know if my Lab Requisition Form was received?

After submitting your Lab Requisition Form, you can follow up with the laboratory to confirm receipt. It's a good practice to keep a record of your submission, including the date and time, to ensure that your patient's tests are processed without unnecessary delays.

Filling out a Lab Requisition form can seem straightforward, but there are common mistakes that can lead to delays or issues with testing. Understanding these pitfalls can help ensure a smoother experience for both patients and healthcare providers.

One frequent error is neglecting to provide the ICD-9 diagnosis code(s). This code is essential for insurance purposes, particularly with Medicare, which often does not cover routine screening tests. Without this information, the laboratory may reject the requisition or the insurance claim may be denied.

Another common mistake is failing to fill in the patient’s date of birth. This detail is crucial for accurately identifying the patient and ensuring that test results are matched correctly. Missing this information can lead to confusion and delays in processing.

Some individuals forget to indicate the patient's gender. The options provided—male or female—are important for certain tests and can affect the interpretation of results. Omitting this detail may lead to miscommunication or errors in the testing process.

Additionally, marking the test urgency is often overlooked. Indicating whether the tests are STAT, ASAP, or routine helps the laboratory prioritize their workload. Without this indication, tests that require immediate attention may not be processed in a timely manner.

People sometimes skip providing the provider’s name and contact information. This information is vital for the laboratory to reach out if there are questions or issues regarding the requisition. Missing provider details can lead to unnecessary delays in patient care.

Another common oversight is not specifying the draw site or the number of sticks required. This information helps the phlebotomist prepare adequately for the blood draw. If these details are missing, it may result in complications during the procedure.

Some patients also fail to indicate whether the sample is fasting or non-fasting. This distinction is important for accurate test results, especially for tests measuring glucose or cholesterol levels. Not clarifying this can lead to inaccurate results and potential re-testing.

It's also important to remember that all sections of the form should be filled out completely. Leaving any section blank can cause confusion or delays in processing. Each piece of information plays a role in ensuring that the laboratory can provide the best possible care.

Lastly, patients sometimes forget to sign and date the form. A signature indicates that the provider has approved the tests and acknowledges responsibility for the requisition. Without this, the laboratory may not proceed with the tests.

By being mindful of these common mistakes, patients and providers can work together to ensure that the Lab Requisition form is completed accurately. This attention to detail can lead to faster results and a more efficient healthcare experience.

When healthcare providers order laboratory tests, they often use several forms and documents in conjunction with the Lab Requisition form. Each of these documents serves a specific purpose in ensuring that the testing process runs smoothly and that patient information is accurately recorded. Below is a list of commonly used forms.

• Patient Consent Form: This document is used to obtain a patient's permission before conducting tests or procedures. It outlines the risks, benefits, and alternatives to the proposed tests, ensuring that patients are informed and can make educated decisions about their healthcare.
• Insurance Authorization Form: This form is necessary for obtaining approval from a patient's insurance provider before performing certain tests. It helps to ensure that the tests will be covered under the patient’s insurance plan, minimizing unexpected out-of-pocket costs.
• Specimen Collection Protocol: This document provides detailed instructions on how to properly collect and handle specimens for testing. It is crucial for ensuring that samples are collected in a manner that preserves their integrity and provides accurate results.
• Test Result Report: After tests are completed, this report summarizes the findings and is sent to the ordering physician. It includes information on the results and any relevant interpretations, aiding in the diagnosis and treatment of the patient.
• Referral Form: In some cases, a provider may need to refer a patient to a specialist for further evaluation or testing. This form includes essential information about the patient and the reason for the referral, facilitating communication between healthcare providers.
• Follow-Up Appointment Form: This document is used to schedule follow-up appointments for patients after test results are received. It helps ensure that patients receive timely care based on their test outcomes.
• Laboratory Safety Data Sheet (SDS): This sheet provides information about the safe handling and potential hazards of laboratory materials and chemicals. It is essential for maintaining a safe working environment in the laboratory.
• Quality Control Log: This log tracks the performance of laboratory tests and equipment over time. It helps ensure that testing procedures meet established standards and that any issues can be addressed promptly.

Each of these documents plays a vital role in the laboratory testing process. Together, they help ensure that patient care is efficient, accurate, and compliant with healthcare regulations.

• Prescription Pad: Like a Lab Requisition form, a prescription pad is used by healthcare providers to order specific tests or medications for patients. Both documents require the provider's information and patient details to ensure accurate processing.
• Referral Form: A referral form is similar in that it facilitates communication between healthcare providers. It allows one provider to refer a patient to another for specialized care, much like how a Lab Requisition directs lab testing.
• Patient Intake Form: This document collects essential information about a patient, including demographics and medical history. Both forms aim to gather necessary data to provide appropriate care and services.
• Insurance Authorization Form: Just as the Lab Requisition may require insurance details for testing coverage, an insurance authorization form is used to obtain approval for specific medical services from insurance providers.
• Medical History Form: This form captures a patient’s past medical issues and treatments. Similar to the Lab Requisition, it helps healthcare providers understand a patient's health background to make informed decisions.
• Discharge Summary: After a patient receives care, a discharge summary outlines the treatment received and any follow-up instructions. Like the Lab Requisition, it serves as an important communication tool between healthcare providers regarding patient care.

When filling out a Lab Requisition form, there are several important dos and don’ts to keep in mind. Following these guidelines can help ensure that the process goes smoothly and that the necessary information is provided accurately.

• Do fill in all required information completely. This includes patient name, date of birth, and diagnosis codes.
• Do specify the type of test or tests needed. Be clear about any special instructions, such as fasting requirements.
• Do provide accurate contact information for the provider. This includes phone numbers and secure fax numbers.
• Do double-check for any errors before submitting the form. Mistakes can lead to delays in testing.
• Don't leave any sections blank. Missing information can cause confusion and may delay processing.
• Don't forget to sign and date the form. An unsigned form may not be accepted.
• Don't use outdated diagnosis codes. Always ensure you are using the most current codes.
• Don't submit the form without confirming the required tests with the attending physician.

By adhering to these guidelines, you can help facilitate a more efficient and effective lab testing process. Accurate and complete forms lead to quicker results and better patient care.

• Misconception 1: The lab requisition form is only for blood tests.

  In reality, this form is used for a variety of tests, including urinalysis, cultures, and special chemistry tests. It serves as a comprehensive tool for ordering multiple types of laboratory analyses.

• Misconception 2: All tests on the requisition are covered by insurance.

  This is not always the case. For example, Medicare does not generally cover routine screening tests. It’s important to verify coverage with your insurance provider beforehand.

• Misconception 3: Fasting is required for all tests.

  While some tests require fasting, others do not. The requisition form clearly indicates whether fasting is necessary for specific tests, so it’s crucial to read the instructions carefully.

• Misconception 4: The form does not need to be filled out completely.

  Completing all required fields is essential. Missing information can lead to delays or issues with processing the tests. Always ensure that every section is filled out accurately.

• Misconception 5: You can drop off specimens at any location.

  This is incorrect. Specimens must be submitted to designated Kaiser Permanente facilities. It’s important to be aware of where to take your samples to ensure they are accepted.

• Misconception 6: The lab requisition form is only for established patients.

  New patients can also use this form for testing. However, it’s advisable to consult with the healthcare provider to ensure all necessary information is included.

• Misconception 7: You can order any test without prior approval.

  Not all tests can be ordered freely. Some tests require prior authorization from a physician. Always check with the healthcare provider to confirm that the requested tests are approved.

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

• Complete all required fields. Ensure that all necessary information, including provider details and patient demographics, is filled out accurately.
• Use correct diagnosis codes. Include the appropriate ICD 9 diagnosis code(s) as Medicare does not generally cover routine screening tests.
• Indicate patient gender. Clearly mark whether the patient is male or female.
• Specify fasting requirements. Note if the test requires fasting, is non-fasting, or needs to be done stat or ASAP.
• Fax the completed form. Send the signed and dated requisition to the designated fax number: 303-404-4030.
• Choose the correct tests. Select the appropriate tests based on the patient's needs and the physician's orders.
• Document the draw site. Indicate where the blood draw will occur and the number of sticks attempted.
• Check for specimen acceptance. Remember that no specimens will be accepted at any Kaiser Permanente facility without prior approval.
• Contact for assistance. If you have questions about tube types or specimen collection, reach out to Laboratory Client Services at 303-404-4050.

Following these guidelines will help ensure a smooth process for laboratory testing.