Free Lab Requisition Form in PDF

Instructions on Writing Lab Requisition

Completing a Lab Requisition form is a key step in ensuring that patients receive the appropriate laboratory tests as ordered by their healthcare provider. This document essentially communicates to the laboratory team what tests are required, based on the patient's current health condition and the physician's diagnosis. It's crucial to fill out this form accurately to avoid any delays or issues with the testing process. Here’s a step-by-step guide to help you navigate through the form efficiently.

1. Start by entering the UPIN/NPI number of the healthcare provider in the designated space.
2. Fill in the Provider's Name section with the full name of the healthcare provider requesting the lab work.
3. Provide the complete address and contact information of the provider, including the phone number and secure fax number.
4. In the section marked **Required**, accurately enter the ICD-9 diagnosis code(s) to justify the need for the requested tests.
5. Select the patient's gender by marking either the MALE or FEMALE box, as applicable.
6. Enter the patient's date of birth in the space provided.
7. Fill in the patient's name, starting with the last name followed by the first name, ensuring it matches the identification used by the patient’s medical records.
8. If applicable, include the Kaiser Medical Record number.
9. Indicate the urgency of the tests by selecting NON-FASTING, STAT, ASAP, or FASTING, and if fasting is selected, specify the duration in hours.
10. For each test category like URINALYSIS, HEMATOLOGY, COAGULATION, etc., mark the boxes next to the tests that are being requested.
11. If requesting CHEMISTRY SINGLE TESTS, mark each test as needed and specify any particular conditions, such as fasting or postprandial (PP) hours for a glucose test.
12. For THERAPEUTIC DRUGS, indicate the specific drug testing requested and mark either PEAK or TROUGH as required, including the date and time of the last dose.
13. Under SPECIAL CHEMISTRY and OTHER TESTING, mark the required boxes for any special or additional tests being requested.
14. If a 24-HOUR URINE TEST is necessary, mark the appropriate box and note that containers can be picked up at any Kaiser Permanente laboratory location.
15. At the bottom of the form, provide the information regarding the DRAW SITE and the number of attempts (STICKS) made, if applicable.
16. Indicate whether the physician was notified in the case of being UNABLE TO DRAW by marking YES or NO.
17. Signature of the provider and date must be included to validate the requisition.
18. Lastly, for any comments, utilize the space provided at the bottom of the form to communicate specific instructions or requests to the laboratory personnel.

After the form is completed and signed, it should be faxed to the number provided on the form. This step is essential to start the process and ensure that the laboratory is prepared to conduct the necessary tests. Remember, accurately filling out this form is crucial for the efficient handling and processing of tests, ultimately contributing to the timely and correct diagnosis and treatment of the patient.

What is a Lab Requisition Form?

A Lab Requisition Form is a document filled out by a healthcare provider that orders specific laboratory tests. It includes important details such as the patient's information, the provider's contact details, the tests being requested, and any special instructions for those tests. This form is crucial for ensuring that the lab carries out the correct tests for the correct patient.

Why is the provider's UPIN/NPI number required on the form?

The provider's Unique Physician Identification Number (UPIN) or National Provider Identifier (NPI) number is required to identify the healthcare provider requesting the tests. This number is essential for billing purposes and ensures that the test results are accurately reported back to the correct healthcare provider.

What does the "ICD 9 DIAGNOSIS CODE" mean and why is it important?

The "ICD 9 DIAGNOSIS CODE" refers to the International Classification of Diseases, Ninth Revision, code that relates to the patient’s diagnosis. This code is crucial because it justifies the need for the requested laboratory tests. It also plays a significant role in billing, as it can affect coverage and reimbursement by insurance providers, including Medicare.

How should the tests be selected on the form?

Tests should be selected based on the patient's needs and the healthcare provider's assessment. The requisition form lists various types of tests, such as urinalysis, hematology, coagulation profiles, chemistry profiles, and more. The healthcare provider must check the appropriate boxes next to the tests that are requested. If specific conditions or circumstances apply (like fasting requirements or the need for STAT results), these should also be indicated on the form.

What is the significance of indicating "MALE" or "FEMALE" on the form?

Indicating the patient's gender as "MALE" or "FEMALE" on the form is important because some laboratory tests may have different reference ranges or implications based on gender. This information helps the laboratory interpret the results accurately and provide the most relevant information for the patient's care.

How is patient confidentiality protected with the use of this form?

Patient confidentiality is protected through adherence to healthcare privacy laws, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States. The form should be handled and transmitted securely, whether through secure fax numbers or other HIPAA-compliant means, to ensure that patient information remains confidential.

What happens if a required test is not listed on the form?

If a healthcare provider needs to order a laboratory test that is not listed on the form, they should contact the lab directly at the provided number to request the additional test. This ensures that patients receive all necessary tests for their care, even if they fall outside the routine options listed on the form.

Why might a provider select the "STAT" option for a test, and what does it imply?

A provider may select the "STAT" option if a test result is urgently needed, often due to a critical health situation that requires immediate attention. Selecting "STAT" tells the laboratory that this test is a high priority and should be processed as quickly as possible to expedite patient care and treatment decisions.

Filling out a Lab Requisition form accurately is crucial to ensure that patients receive proper medical testing and that the results are interpreted correctly. Unfortunately, errors can occur, which may lead to delays or inaccurate medical evaluation.

One common mistake is misidentifying the patient's gender, marked by the choice between male and female. This information is critical because certain tests interpret results differently based on the patient's gender, affecting the accuracy of diagnoses.

Failing to indicate the urgency of the test, such as marking the form as STAT, ASAP, or routine, is another error that can disrupt laboratory priorities. Laboratories often prioritize tests based on these designations, so incorrect or missing information can lead to unwarranted delays.

Incorrectly or not entering the ICD 9 diagnosis codes is a significant oversight. These codes are necessary for insurance companies, including Medicare, to justify the need for the tests. Without these codes or with incorrect codes, patients may face issues with insurance coverage.

Another issue arises when the provider's details are incomplete or inaccurate. Essential details like the UPIN/NPI number, provider name, address, and contact information enable clear communication and proper test attribution. Any errors or omissions can complicate the billing process and the delivery of results.

Not specifying if the patient is fasting or the number of fasting hours prior to the test can affect test outcomes, especially for tests like glucose levels or lipid panels. This information is critical for interpreting results accurately.

Omitting the date and time for the last dose under the therapeutic drugs section can lead to misunderstandings in drug monitoring and efficacy tests. Accurate timing is essential for interpreting concentrations of drugs like digoxin, lithium, or vancomycin.

Another commonly overlooked detail is the selection of the specific tests to be administered. Checking the appropriate boxes ensures the correct tests are performed. Forgetting to mark requested tests may result in incomplete diagnostic information.

Many people also neglect to provide detailed information where required, such as specifying the glucose test duration or the exact type of urine or blood samples needed. Vague or incomplete requisitions can lead to incorrect test processing.

Last, ensuring that the provider's signature and date are on the form is crucial. This confirms the order's authenticity and approval. Missing signatures can invalidate the requisition, preventing any testing from being conducted.

In the world of healthcare, various forms and documents accompany the journey of a patient's sample from the moment it is ordered to the time results are delivered. The Lab Requisition form is a vital document initiating this process. It specifies the tests ordered by the healthcare provider, the patient's information, and any special instructions for the laboratory. However, several other documents often play crucial roles in ensuring accurate and efficient processing of laboratory tests. Together, they form a comprehensive packet of information that facilitates communication and understanding between healthcare providers, laboratories, and patients. Here's a look at four such documents that frequently accompany the Lab Requisition form.

• Patient Consent Forms: These documents are essential for informing patients about the tests that are being performed, the reasons for these tests, and any potential risks involved. They ensure that the patient agrees to the procedure after understanding its implications fully.
• Insurance Information Forms: These forms contain details about the patient's insurance coverage. Lab tests can be expensive, and having the insurance information upfront helps the laboratory to process claims efficiently and informs the patient about any potential out-of-pocket costs.
• Specimen labels: Each sample collected from a patient needs to be accurately labeled with identifiers like the patient's name, date of birth, and the specific test to be conducted. This documentation is critical to prevent mix-ups in the lab and ensure that the test results match the correct patient.
• Test-Specific Requirement Sheets: Certain tests may have specific requirements regarding specimen collection, handling, and transportation (e.g., temperature control, fasting). These sheets provide detailed instructions to ensure that the samples are collected and maintained correctly, which is crucial for obtaining accurate test results.

While the Lab Requisition form starts the testing process, it's the combination of all these documents that ensures a smooth workflow and accurate results. The requisition form details what needs to be done, while the other documents provide the how, when, and by whom, covering all bases from consent to billing, and from specimen handling to result delivery. Together, they are pivotal in facilitating high-quality patient care through precise and efficient laboratory testing.

The Lab Requisition form shares several similarities with a Patient Registration Form, both foundational in healthcare administration. A Patient Registration Form collects vital patient information such as name, contact details, address, and insurance information at the time of hospital or clinic registration. Similar to the Lab Requisition form, it serves as a critical first step in the care process, ensuring that healthcare providers have the necessary data to begin treatment or diagnostic procedures. Both documents are essential in linking patient information to specific healthcare services, thus facilitating a seamless care delivery process.

Another document akin to the Lab Requisition form is the Prescription Form used by healthcare providers. This form is designed to communicate a provider's medication orders to a pharmacy. It typically includes the patient's name, the prescribed medication, dosage instructions, and the prescriber's information. Like the Lab Requisition form, which specifies tests to be conducted, the Prescription Form conveys critical information needed to proceed with a patient’s care, in this case, through medication rather than diagnostic tests. Both play pivotal roles in the healthcare process, guiding subsequent steps in patient care.

The Radiology Order Form, used when imaging services like X-rays, MRIs, or CT scans are needed, also parallels the Lab Requisition form in purpose and function. It contains patient identification, the requested procedure, clinical justification for the imaging, and the ordering physician's details. This specificity ensures the imaging department conducts the correct procedure, just as the Lab Requisition form directs the lab to perform specific tests. Both forms are instrumental in the diagnostic process, guiding medical personnel in executing the precise services required for patient evaluation.

Similarly, the Referral Form, which physicians use to direct patients to specialists or other healthcare services, mirrors the Lab Requisition form’s intent of guiding patient care to the appropriate next steps. It includes patient information, the reason for referral, and the specialty service or provider to which the patient is being referred. Both documents are vital in the coordination of care, ensuring patients receive the specialized tests, assessments, or treatment needed beyond the initial healthcare provider’s scope.

Lastly, the Consent for Treatment form, while primarily focused on legal and ethical considerations, also complements the Lab Requisition form's functionality. It documents the patient's agreement to undergo the specified medical intervention or procedure detailed in other forms, such as surgeries, treatments, or in this context, laboratory tests. By obtaining informed consent through this form, healthcare providers ensure that patients or their guardians understand and agree to the tests requested on the Lab Requisition form, thereby upholding patient rights and autonomy within the care process.

Correctly filling out a Lab Requisition form is essential for ensuring that the laboratory processes your test accurately and efficiently. Below are some guidelines on what you should and shouldn't do when completing this form.

• Verify the UPIN/NPI# and the provider's name are filled out correctly. This ensures the test results are attributed to the correct healthcare provider.
• Ensure the patient's name and date of birth are accurately filled to avoid any identification errors.
• Indicate clearly whether the patient is fasting or if the tests are to be carried out ASAP, STAT, or are routine. This information is critical for the lab to prioritize the sample processing correctly.
• Provide a detailed ICD 9 DIAGNOSIS CODE(s) as required. This helps in ensuring that Medicare or other insurance providers cover the tests when applicable.
• Check the correct boxes for the tests needed. Accurately selecting the tests will prevent any delays in processing.
• Include the date and time of the last dose for therapeutic drugs testing to ensure accurate interpretation of the results.

• Leave any required fields, such as patient information or provider details, blank. Incomplete forms can result in delays or the tests not being processed.
• Forget to sign and date the form. The provider’s signature verifies that the tests are approved and needed for the patient’s care.
• Misinterpret the purpose of the test types, for instance, choosing "non-fasting" when "fasting" hours are required for accurate results.
• Overlap tests unnecessarily. Be sure each selected test is necessary for the diagnosis or health screening in question to avoid redundant testing.
• Assume routine tests are covered by Medicare without verifying the ICD 9 DIAGNOSIS CODE(s) corresponds with Medicare’s coverage policies.
• Use the form to request tests not listed without calling the number provided for other tests. Authorization is often required for tests not specified on the form.

There are several misconceptions about Lab Requisition forms that can lead to confusion or errors in patient care. Let’s clarify some of the most common misunderstandings:

• Any provider can complete the form: Only a licensed healthcare provider authorized to order tests, such as physicians, nurse practitioners, or physician assistants, can legally complete a lab requisition form.
• Tests are automatically covered by insurance: Many believe that if a test is on the Lab Requisition form, it’s covered by insurance. However, coverage depends on the patient’s insurance plan and whether the test is deemed necessary based on the diagnosis code provided.
• Routine screenings are always covered: The form specifically mentions that Medicare does not generally cover routine screening tests unless they are deemed medically necessary. It’s a common misconception that all routine screenings are covered by all insurers.
• Any test can be requested at any time: Tests indicated on the Lab Requisition form are selected by the healthcare provider based on the clinical need and patient’s health status. Not all tests are appropriate for all situations.
• Results are immediately available: Some patients assume that lab results will be available right after the tests are completed. In reality, the turnaround time varies based on the type of test.
• The form doesn’t need to be signed: The Lab Requisition form requires the provider’s signature to validate the order. Unsigned forms might not be processed.
• All sections of the form must be filled out for all patients: While it’s crucial to fill in all required information, some sections of the form may not apply to every patient and test requested; for example, fasting specifications.
• Provision of diagnosis code is optional: The form clearly marks the ICD 9 DIAGNOSIS CODE(s) as required. This code helps justify the need for the tests and is crucial for insurance coverage.
• Lab containers for urine or stool samples can be returned to any facility: The form specifies that 24-hour urine containers can be picked up at any Kaiser Permanente laboratory location, but it doesn’t mean samples can be returned to any facility. No specimens will be accepted at any Kaiser Permanente facility without following proper protocol.

Understanding these misconceptions is vital for both healthcare professionals and patients to ensure the lab requisition process runs smoothly and effectively.

Filling out a Lab Requisition form is an essential task in ensuring that patients receive the correct laboratory tests and that the results are accurately reported back to the requesting physician. Below are nine key takeaways to keep in mind when completing and using the Lab Requisition form:

• Every section of the Lab Requisition form must be completed with accurate and clear information, as this ensures that the laboratory can process the test requests without unnecessary delays.
• The provider’s UPIN/NPI number, name, address, phone number, and secure fax number are critical for validating the request and facilitating communication between the lab and the provider.
• Required Fields: Key sections such as ICD 9 Diagnosis Code(s) are mandatory because they justify the need for the requested tests, especially since Medicare has specific coverages for diagnostic testing versus routine screening.
• Clearly indicating the patient's information, including their name, date of birth, and sex, is crucial for correctly identifying the patient and ensuring that the test results are accurately reported.
• Specifying if the tests are needed urgently (STAT, ASAP) or if the patient is fasting is important for the lab to prioritize and correctly process the samples.
• Selecting the correct tests from the list provided on the form requires careful attention to avoid any unnecessary or incorrect testing. This selection must align with the clinical assessment and diagnostic needs of the patient.
• Providers must fax the signed and dated form to the specified fax number to order the tests. An original signature may be required for authenticity and compliance reasons.
• Understanding and utilizing the correct test codes (e.g., URINALYSIS, HEMATOLOGY, CHEMISTRY PROFILES) helps in precisely conveying the test requirements, thereby minimizing errors.
• Any additional instructions or comments related to the test request should be clearly noted in the provided sections to guide the laboratory personnel in handling and processing the tests appropriately.

Attention to detail and adherence to these guidelines when completing the Lab Requisition form not only facilitate efficient and accurate testing but also enhance patient care through timely diagnosis and treatment.