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The document is a Lab Test Request Form for Virology and Immunology, detailing required patient and specimen information for various viral tests. It emphasizes the importance of complete information to avoid specimen rejection and provides instructions for submitting specimens to the Louisiana Department of Health's Office of Public Health Central Lab.

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What information must be included on a laboratory request for?

The laboratory test request must provide the following information: Ordering providers full name, address, phone number, and provider signature. Patients name and date of birth. Test(s) requested. Diagnosis and/or ICD-10 Codes. Date and time of order.

What is the purpose of a lab requisition form?

A lab requisition form is used by healthcare professionals to request laboratory tests such as or blood testing. They are also called test requisition forms. When blood, , or tissue is sent to a lab from a doctors office a lab requisition form is required.

How to write a lab request?

What Patient details (name, address, telephone number, birth date, gender, etc.) Requester details. Type of primary sample. Examination(s) requested. Clinical information relevant to the laboratory. Date, time and place of sample collection. Date and time of receipt of the sample at the laboratory.

What goes on a lab request form?

Submitting Requests for Tests Patient name, sex, birth date, include unique ID number, lab reference number. Collection date and time. Diagnosis Code. Type of specimen submitted, indicate serial and timed collection. Patient fasting conditions (if applicable) Interval and total volume if a timed collection.

What is a medical laboratory request form?

Laboratory request forms provide information about the laboratory test being requested for. They carry demographic data and other information such as location of patient, laboratory number, doctors name, signature of the doctor, telephone number of the requesting doctor.

laboratory test request form pdf

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What is the lab order form?

What are Lab Order Forms? The Lab Order Form allows you order testing on patients bodily fluid or tissue to obtain information about their health. This article is practices that are creating lab orders to print for patients or fax to lab vendors.

What is a laboratory request form?

Background information: The laboratory request form is a communication link between the clinicians and the laboratory staff. It contains demographic details of the patient including full names, age and gender; the test required; location of the patient; date and time of request among other details.