Laboratory Services Outpatient Order Form 660 N - lfh 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out the 'Patient Information' section. Enter the patient's last name, first name, middle initial, today's date, social security number, email address, and date of birth.
3. Next, provide details for the 'Ordering/Referring Physician.' Include their name, office/fax number, and signature.
4. In the 'Signs or Symptoms/Diagnosis' section, specify any relevant information before rendering services. If ordering multiple tests, indicate a sign or symptom for each test/treatment along with the appropriate ICD-9 code.
5. Select the required tests from the list provided. You can check off routine or STAT options as needed.
6. Finally, ensure all sections are completed accurately before saving your changes and exporting the form for submission.

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