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The document is a Test Requisition Form from The Great Plains Laboratory, detailing the necessary patient and physician information required to process laboratory tests. It includes sections for insurance information, payment methods, and a list of available tests with associated costs. Additionally, it outlines policies regarding insurance coverage, particularly for Medicare and various insurance providers, as well as privacy practices related to patient data.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (107 Votes)
2014	4.8 Satisfied (69 Votes)

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What information must requisitions for laboratory tests include?

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 a general laboratory requisition?

General laboratory requisition forms are used by physicians when performing comprehensive medical tests as part of routine checkups, diagnoses and benchmarking new patients.

What happened to the Great Plains Laboratory?

First as Great Plains Laboratory and now as Mosaic Diagnostics, our comprehensive testing solutions help identify the root causes of chronic health conditions.

What is a laboratory 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.

What is the purpose of a requisition form?

A requisition is a formal request for obtaining a product or service, typically initiated by a business. The requisition process typically requires standardized documents, known as requisition forms, to maintain an audit trail, although most are electronic forms.

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What is the purpose of a requisition from in a laboratory setting?

Background: A laboratory requisition form (LRF) is the main communication link between the laboratories and the clinicians. In a cytopathology laboratory, incomplete forms with inadequate information significantly impact the quality of the results and waste precious time of the lab.

What is laboratory test request form?

The laboratory request form (LRF) is a communication link between laboratories, requesting physicians and users of laboratory services.

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What information must requisitions for laboratory tests include?

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