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Outpatient Laboratory Requisition Form 2026
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- Click ‘Get Form’ to open the Outpatient Laboratory Requisition in the editor.
- Begin by filling out the 'Ordering Physician' section, ensuring you include your address and MSP practitioner number for accurate processing.
- Complete the 'Patient' details, including surname, first name, PHN number, and date of birth. Highlighted fields are mandatory to avoid delays.
- Indicate any special instructions such as 'STAT order' by providing a contact telephone number if necessary.
- Fill in the relevant tests required by checking the appropriate boxes under Hematology, Chemistry, Microbiology, and other sections as needed.
- Finally, ensure that you sign and date the form at the bottom before submitting it through our platform for processing.
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Related links
each requisition form for laboratory services must clearly identify: Patient name, sex, birth date, include unique ID number, lab reference number Collection
PUBLIC HEALTH LABORATORY. 12750 ERICKSON AVENUE. DOWNEY, CA 90242. PHONE (562) COMPLETE THIS FORM FOR EACH SPECIMEN AND CLICK THE PRINT BUTTON AT THE BOTTOM.Read more