Request for Testing Hemostasis Reference Laboratory (fill in 2026

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  1. Click 'Get Form' to open it in the editor.
  2. Begin by filling out the 'Patient Identification' section. Enter the patient's name, date of birth, and sex (M/F). Ensure that this information matches the sample label.
  3. In the 'Specimen Information' box, input the collection date and time. Select whether it was collected in the morning or afternoon.
  4. Choose the tests required by checking the appropriate boxes under 'Routine Tests'. Refer to the drawing instructions for specific sample requirements.
  5. Complete the 'Physician or Authorized Person Ordering Test' section with both first and last names. Include any necessary ICD10 codes.
  6. Fill in the 'Send Report To' section with institution details, including fax number and contact person’s phone number.
  7. Review all entered information for accuracy before submitting your form through our platform.

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Hemostatic screening tests, prothrombin time (PT) and activated partial thromboplastin time (APTT), are frequently used to assess the bleeding risk, for example, before an operation or an invasive procedure.
Two laboratory tests are used commonly to evaluate coagulation disorders: Prothrombin Time (PT) which measures the integrity of the extrinsic system as well as factors common to both systems and Partial Thromboplastin Time (PTT), which measures the integrity of the intrinsic system and the common components.
A healthcare provider like a hematologist can diagnose hemostasis problems based on your symptoms and blood tests that analyze the clotting-related components in your blood. Blood tests may include: Complete blood count (CBC) Platelet count.
This evaluation includes peripheral smear for platelet morphology and number, platelet count, bleeding time, activated partial thromboplastin time (aPTT), prothrombin time (PT), and clot retraction. Normal results of these tests exclude all but the mildest disturbances of hemostasis.
Few tests of primary hemostasis are available to general practitioners. These include a platelet count, a buccal mucosal bleeding time (BMBT), genetic testing for specific inherited disorders, and measurement of vWf concentrations. Screening tests: Platelet count, BMBT, platelet function analyzer testing.

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