Outpatien blood request form 2026

1. Click ‘Get Form’ to open the outpatient blood request form in the editor.
2. Begin by entering the patient’s name (last, first, MI) in the designated field. Ensure accuracy as this is crucial for identification.
3. Fill in the patient’s date of birth and sex. This information helps in categorizing the request appropriately.
4. Complete the physician's details including their name and contact number. This ensures that any follow-up can be conducted smoothly.
5. In the billing section, select the appropriate option: wholesale account, insurance billing, or self-pay. Fill out all relevant fields based on your selection.
6. For insurance billing, complete sections 1 through 6 with accurate patient address, phone number, and insurance details to avoid delays.
7. Indicate any required tests by checking the appropriate boxes under 'Blood Bank Tests' and provide ICD-9 codes where necessary.
8. Finally, ensure that all signatures are collected where indicated before submitting the form for processing.

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