Litholink form blank 2026

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The document is a Test Request Form from Litholink, a laboratory specializing in 24-hour urine testing for kidney stone formers. It includes sections for patient and physician information, diagnosis details, and specific tests to be ordered with corresponding CPT codes. The form outlines the process for obtaining and returning an At-Home Kit for urine collection, emphasizing the importance of completing all required information to avoid sample rejection.

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Click ‘Get Form’ to open the litholink form blank in the editor.
Begin by entering your Date of Birth in the designated field. This is crucial for identifying your medical records.
Fill in the Physician's Last Name and First Name, along with their contact information including Street Address, City, State, Zip Code, and Phone Number.
Complete the Patient Information section by providing your Last Name, First Name, Gender (M/F), Last 4 Digits of SSN, and MRN #.
In the Diagnosis section, select 'N20.0 Kidney Stones' or specify another diagnosis using ICD-CM format.
Choose the appropriate Cystine Urine Panel or Kidney Stone Urine Panel based on your needs. Ensure you select only one option for each panel.
For Serum/Blood Collection Location, indicate whether it will be at LabCorp Patient Service Center or another facility.
Finally, review all entered information for accuracy before submitting the form back to Litholink with your completed urine samples.

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2017	4.8 Satisfied (27 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I prepare for Litholink testing?

You must collect all of your for 24 hours. Do not refrigerate your . Stop taking Vitamin C (pill form, vitamins, and/or supplements) that is greater than 100 mg per day 5 days prior to the start of your At-Home kit. Vitamin C occurring in foods and drinks can be ingested as normal.

How do I get my Litholink results?

You can also retrieve your results online through a web service called Labcorp Link. Labcorp Link lets you order, view, share, manage, and analyze lab results anytime, anywhere.

What does a Litholink test show?

A Litholink test is an analysis of your childs . The daily levels of minerals, fluid content and / or other components are given in this report. The report gives the doctor information to help determine the cause of kidney stones.

Does labcorp do 24-hour test for kidney stones?

Labcorp is the premier provider of the Litholink 24-hour testing for kidney stone prevention. Through sophisticated algorithms created by the leading specialists in the disease, this testing provides on the test report itself patient-specific treatment recommendations and other clinical and patient support.

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