Blank Lab Requisition PDF Template

1. What is a Lab Requisition Form?

   A lab requisition form is a document provided by a healthcare provider instructing a laboratory on what tests to conduct on a patient's samples, such as blood, urine, or tissue. This form contains critical information like the patient's name, date of birth, the tests to be performed, and the physician's information, including their address, phone number, and secure fax number. These forms ensure that the lab accurately understands which tests are needed, thus playing a crucial role in patient care.

2. How do I understand the test abbreviations listed on the form?

   The test abbreviations on a lab requisition form correspond to various medical tests. For example, "CBC/AUTO DIFF" refers to a Complete Blood Count with automated differential, a test that measures different components of the blood. Other abbreviations, such as "CMP" (Comprehensive Metabolic Panel) and "TSH" (Thyroid-Stimulating Hormone), represent specific panels or tests targeted at assessing a person's metabolic function and thyroid health, respectively. It's essential to consult with the healthcare provider for a complete understanding of these abbreviations and the reasons behind each test's selection.

3. Is it mandatory to fill in all sections of the form?

   Yes, completing all sections of the requistion form is required. Do note that Medicare does not generally cover routine screening tests, making it crucial to provide complete information, including the ICD 9 Diagnosis Code(s), to ensure that any tests performed are adequately covered and justified. Failure to fill out all parts may result in delays or refusal of the requested diagnostic services.

4. Can I request any test not listed on the form?

   To request tests not listed on the standard lab requisition form, the provider must call a specific number provided on the form (in this case, 303-743-5330). This flexibility ensures that healthcare providers can request additional tests crucial for comprehensive patient care, even if they are outside the form's predefined options.

5. What should I do if I have questions about specimen collection or need further clarification?

   If questions or concerns arise about specimen collection, tube types, or other issues not clearly addressed by the requisition form, healthcare providers can contact the Laboratory Client Services Department directly during their operating hours (M-F 8am-6pm) at 303-404-4050. This support line ensures that providers receive the necessary guidance for accurate and efficient specimen collection and submission.

Filling out a Lab Requisition form is a critical step in ensuring that patients receive accurate and timely medical diagnostics. However, mistakes in this process can lead to delays, incorrect testing, and ultimately, a negative impact on patient care. Here are eight common mistakes people make when filling out these forms:

1. Ignoring the **Required** sections, such as the ICD 9 DIAGNOSIS CODE(s), which can result in Medicare or other insurance providers denying coverage for the tests.

2. Failing to check the correct boxes under "FILL IN ALL INFORMATION" regarding the patient's gender, which can affect certain test results.

3. Leaving the DATE OF BIRTH blank or entering it incorrectly, as this is crucial for identifying the patient and ensuring appropriate test reference ranges are used.

4. Not providing a complete PATIENT NAME, including both last and first names, which is essential for accurate record-keeping and result reporting.

5. Omitting the Kaiser Medical Record # if applicable, leading to issues with accessing patient records or applying the tests to the correct individual.

6. Skipping the selection for fasting status or incorrectly marking the fasting hours, which can significantly impact test outcomes, particularly for glucose and lipid panels.

7. Inaccurately marking or failing to specify the tests requested by not checking the appropriate boxes under the testing sections such as URINALYSIS, HEMATOLOGY, etc., which may result in incomplete diagnostic information.

8. Forgetting to include the provider's signature and the date, a common oversight that can invalidate the requisition, as this is a verification of the tests' necessity.

Avoiding these mistakes requires a careful and comprehensive approach to filling out the Lab Requisition form. It's about ensuring accuracy at every step, recognizing the significance of each piece of information, and understanding that what may seem like a minor oversight could have major implications for patient care.

When managing patient care, especially in contexts that necessitate laboratory testing, a suite of documents and forms usually complements the Lab Requisition Form. These documents support the requisition process, ensure the accuracy and privacy of patient information, and aid in the comprehensive management of the patient's health. Below is a description of several forms and documents that are regularly used alongside the Lab Requisition form.

• Patient Consent Form: This document is critical as it records the patient's consent for the laboratory tests to be performed. It outlines the nature of the tests, the procedures involved, and any risks or benefits associated with them.
• Insurance Verification Form: Before laboratory services are performed, it's essential to verify the patient's insurance coverage to understand which tests are covered and to what extent, avoiding unexpected expenses for the patient.
• Physician Orders: Detailed instructions from the physician or healthcare provider specifying which laboratory tests are required. This document often supplements the Lab Requisition Form by providing additional context or specific directives regarding the tests to be conducted.
• Specimen Collection and Handling Instructions: A document that details the procedures for collecting, preserving, and handling specimens to ensure their integrity and the accuracy of test results. It may include guidelines for different types of samples such as blood, urine, or tissue.
• Privacy Notice: A document that explains how a patient's personal and medical information will be used and protected. This notice is part of compliance with privacy laws like the Health Insurance Portability and Accountability Act (HIPAA).
• Test Result Form: After laboratory tests are conducted, the results are recorded on this form. It may include interpretations or remarks by the laboratory personnel to guide the physician in understanding the outcomes.
• Referral Form: If the results from the laboratory tests indicate the need for further consultation with a specialist, a referral form may be filled out. This document includes information about the patient, the reason for the referral, and the type of specialist required.
• Patient History Form: A comprehensive record of the patient's medical history is often required alongside the Lab Requisition form. This form includes previous conditions, ongoing treatments, and familial health history, providing context for interpreting laboratory results.

These documents play a vital role in the laboratory testing process, from ensuring legal compliance and patient consent to guiding the collection and interpretation of samples. Together, they form a cohesive ecosystem that supports the delivery of accurate, informed, and ethical healthcare.

• Prescription Form: Similar to a Lab Requisition form, a Prescription Form requires the healthcare provider to fill in specific patient information, medication details, and dosage instructions. Both forms are used by healthcare professionals to communicate necessary medical actions for a patient's care to another party, whether it's a pharmacy or a lab.

• Medical Referral Form: Just like the Lab Requisition form, a Medical Referral Form is used to refer a patient to specialist services or further testing. Both include patient information, the requesting physician's details, and specify the type of service or test needed.

• Consent Form for Medical Procedures: This form shares similarities with the Lab Requisition form as it requires patient identification, the physician's signature, and a detailed account of the procedure—in this case, specific laboratory tests—similarly ensuring informed consent and authorization.

• Prior Authorization Form: Much like a Lab Requisition form, which outlines specific tests approved by the attending physician, a Prior Authorization Form is needed for insurance purposes to approve certain medical services, procedures, or medications, detailing medical necessity.

• Insurance Claim Form: Similar to the information supplied in a Lab Requisition form, Insurance Claim Forms require detailed patient information, provider details, and the services performed (in this case, laboratory tests) to ensure proper billing and reimbursement.

• Emergency Contact Form: While primarily used for gathering contact information, it similarly includes detailed patient information as found in a Lab Requisition form, crucial for ensuring quick and accurate communication in a patient's care circle.

• Patient Registration Form: This document collects comprehensive patient information—such as personal details, medical history, and insurance information—much like a Lab Requisition form, essential for creating a patient's profile within a healthcare setting.

• Test Order Form for Diagnostic Centers: Very much akin to a Lab Requisition form, this type of form is used when ordering diagnostic imaging or other non-laboratory tests, including the patient's information, requested tests, and physician details, facilitating accurate and efficient testing.

When completing the Lab Requisition form, adhering to a specific set of guidelines ensures accurate processing and prevents delays. Below are the dos and don'ts to consider:

• Verify the UPIN / NPI# and provider name are filled in accurately to ensure proper identification and billing.
• Include a complete address and both phone and secure fax numbers to enable clear and secure communication.
• Mark the required ICD 9 DIAGNOSIS CODE(s) clearly since Medicare coverage depends on these codes.
• Indicate the patient's gender, date of birth, and full name to avoid any confusion with patient records.
• Choose the correct test requisitions and note special instructions like FASTING, NON-FASTING, STAT, or ASAP for precise testing protocols.
• Ensure that the date and time of the last dose are mentioned for therapeutic drugs needing monitoring.

• Leave required fields like the ICD 9 DIAGNOSIS CODE(s) blank as this information is crucial for insurance coverage and test accuracy.
• Forget to specify the sample type (blood, urine, stool, swab) as this is essential for the laboratory to process the samples correctly.
• Fail to obtain the provider's signature and the date, as this is a necessary part of the form's validity.

By carefully following these guidelines, the Lab Requisition process can be executed smoothly, ensuring that the patient receives the most accurate and timely care possible.

There are several misconceptions regarding the Lab Requisition form that need to be clarified to ensure that patients and healthcare providers have a correct understanding of its purpose and requirements. These misconceptions can lead to confusion and delays in getting necessary lab work done.

• Only for Kaiser Permanente Facilities: A common belief is that the Lab Requisition form is exclusively for use within Kaiser Permanente laboratories and cannot be utilized for lab work at non-Kaiser facilities. While the form is designed for Kaiser's system, and its directions indicate Kaiser's process, healthcare providers may still require similar information for tests at other labs. It serves a standardized purpose in detailing needed tests, irrespective of the lab's affiliation.
• Medicare Coverage: Another misconception is that Medicare will not cover any tests ordered through this form. While it’s true the form notes "Medicare does not generally cover routine screening tests," this does not mean all tests listed or ordered won't be covered. Coverage depends on the individual's Medicare plan and the necessity of the test as determined by the healthcare provider. It's essential to verify with Medicare or insurance providers about coverage specifics.
• Provider Signature Not Necessary: Some may misunderstand the importance of the provider’s signature on the requisition form. The form clearly states it must be "signed and dated" by the provider. This requirement is crucial for the validity of the lab order. Without the healthcare provider’s signature, the lab may not proceed with the tests, as this serves as a verification and authorization of the requested services.
• No Appointment Necessary for Routine Tests: A notable aspect often overlooked is the convenience offered by Kaiser facilities for routine laboratory testing. It is believed that appointments are always needed. However, the form specifies, "No appointments necessary for routine laboratory testing at any Kaiser Permanente lab facility," streamlining the process for patients needing common tests without the hassle of scheduling an appointment. This facilitates easier access to necessary lab services.

Understanding these misconceptions is vital for patients and healthcare providers to navigate the Lab Requisition process smoothly and efficiently. Correcting these misunderstandings ensures that patients receive the tests they need in a timely manner, with clarity on coverage, requirements, and procedures.

Filling out and using a Lab Requisition form correctly is critical for ensuring accurate and efficient patient care. Below are key takeaways that healthcare providers should consider:

• Complete all patient information accurately, including the patient's full name, date of birth, gender, and any specific patient identifiers such as the Kaiser Medical Record number.
• It's mandatory to include the provider's details, such as the UPIN/NPI number, name, address, phone number, and secure fax number, to ensure clear communication and prompt results.
• For Medicare patients, remember that routine screening tests are generally not covered unless justified by an appropriate ICD 9 Diagnosis Code(s), which must be provided on the form.
• Mark the tests clearly, making sure to distinguish between different test categories such as Urinalysis, Hematology, Coagulation, Chemistry Profiles, Chemistry Single Tests, Therapeutic Drugs, Special Chemistry, Other Testing, and 24 Hour Urine Tests.
• Indicate any necessary details for specific tests, such as fasting requirements, date and time of the last dose for therapeutic drug monitoring, or specifying if a test should be prioritized as STAT or ASAP.
• Before faxing the requisition, double-check that the form is signed and dated by the provider, as this is a legal requirement for the lab to process the tests.
• For specimen collection instructions, tube types, or other queries related to the test preparation and process, healthcare providers should utilize the available contact information for the Laboratory Client Services Department.
• Remember, no specimens will be accepted at any Kaiser Permanente facility without a properly completed Lab Requisition form. For tests not listed on the form, the provider must directly call the specified number to order.

Attention to detail and adherence to instructions on the Lab Requisition form facilitate timely and accurate test results, contributing significantly to the quality of patient care.