HUMBOLDT DIABETES Lab Requisition PROJECT HDP# 2025

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The document is a lab requisition form for the Humboldt Diabetes Project, detailing patient information, requested tests, and laboratory panels related to diabetes and other health assessments. It includes sections for clinician signatures, insurance details, and various laboratory tests categorized under chemistry, hematology, serology, and microbiology. Additionally, it outlines Medicare reimbursement guidelines for the tests.

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Click ‘Get Form’ to open the HUMBOLDT DIABETES Lab Requisition in the editor.
Begin by entering the patient’s name and date of birth (DOB) in the designated fields. Ensure accuracy for proper identification.
Fill in the age, requesting clinician's name, and their signature. This information is crucial for processing the requisition.
Complete the responsible party/insured name section along with their contact details including street address, city, state, zip code, and phone number.
Select the appropriate insurance provider from options like Labcorp or Quest Diagnostics. Indicate whether fasting or non-fasting tests are required.
Choose between 'Stat' or 'Routine' for test urgency and specify any panels needed by checking relevant boxes.
Provide comments and clinical information if necessary to assist healthcare providers in understanding the patient's needs.

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