Blank Lab Requisition Form

1. What is a Lab Requisition form?

   A Lab Requisition form is a document that healthcare providers use to order laboratory tests for patients. This form includes essential patient information, the specific tests requested, and the provider's details. It serves as a communication tool between the healthcare provider and the laboratory.

2. What information is required on the Lab Requisition form?

   Essential information includes:

   • Provider's name and contact details
   • Patient's name and date of birth
   • ICD-9 diagnosis codes
   • Type of tests requested
   • Special instructions such as fasting or urgency (STAT, ASAP)

   All sections must be filled out completely to ensure accurate processing of tests.

3. How should the form be submitted?

   The completed and signed Lab Requisition form should be faxed to the designated laboratory number, which is 303-404-4030. It is crucial that the form is sent securely to protect patient information.

4. What if a patient requires multiple tests?

   The form allows for the selection of multiple tests. Providers should check all applicable tests on the requisition form. If additional tests are needed that are not listed, the provider must call 303-743-5330 to order those tests directly.

5. What does the term "non-fasting" mean on the form?

   "Non-fasting" indicates that the patient does not need to abstain from food or drink before the test. However, some tests may require fasting, and this should be specified on the form. Always follow the instructions provided by the healthcare provider regarding fasting requirements.

6. What should be done if a patient cannot be drawn for a sample?

   If the healthcare provider is unable to draw blood or collect a sample, they should indicate this on the form. It is also recommended to notify the physician of the situation to determine the next steps for the patient's care.

7. Where can patients pick up 24-hour urine containers?

   Patients can pick up 24-hour urine containers at any Kaiser Permanente laboratory location. No appointment is necessary for this service, making it convenient for patients to obtain the necessary materials for testing.

Filling out a Lab Requisition form accurately is crucial for ensuring that patients receive the appropriate tests and care. However, there are common mistakes that can lead to delays or complications. One frequent error occurs when individuals forget to include the ICD 9 diagnosis code(s). This code is essential for billing and insurance purposes. Without it, the laboratory may not process the tests, leaving the patient without necessary results.

Another mistake is failing to provide complete patient information. Omitting details such as the patient's name or date of birth can create confusion and hinder the identification process. It is vital to ensure that all sections of the form are filled out clearly and accurately. This attention to detail can prevent unnecessary delays in obtaining test results.

In addition, many people neglect to indicate the appropriate testing urgency. Options such as STAT or ASAP must be marked if immediate results are needed. Without this indication, the laboratory may process the tests at a routine pace, which could be detrimental to the patient’s health.

Lastly, individuals sometimes overlook the importance of signing and dating the form. A signature confirms that the tests have been ordered by a qualified provider. Without it, the laboratory may refuse to accept the requisition. Taking the time to review the form before submission can help avoid these common pitfalls and ensure that patients receive timely and effective care.

The Lab Requisition form is an essential document used in medical settings to request specific laboratory tests for patients. Alongside this form, several other documents are often utilized to ensure accurate testing and billing. Below is a list of related forms and documents commonly associated with the Lab Requisition form.

• Patient Consent Form: This document ensures that patients understand the procedures and tests being performed. It typically includes information about potential risks and benefits, allowing patients to provide informed consent before any testing occurs.
• Insurance Information Form: This form collects details about the patient’s insurance coverage. It helps verify eligibility for tests and procedures, ensuring that the laboratory can bill the insurance provider appropriately.
• Medical History Form: A comprehensive overview of a patient's past and current health conditions, medications, and allergies. This information is crucial for interpreting lab results accurately and tailoring medical care.
• Test Result Report: After the laboratory processes the samples, this report details the findings of the tests performed. It is sent to the healthcare provider and may also be shared with the patient.
• Referral Form: Used when a patient is referred from one healthcare provider to another. This form includes relevant medical history and the reason for the referral, ensuring continuity of care.
• Specimen Collection Guidelines: This document outlines the proper procedures for collecting samples, including any necessary preparations for the patient. It helps ensure that specimens are collected correctly to avoid contamination or errors.
• Follow-Up Care Instructions: After tests are completed, this document provides patients with guidance on next steps, including when to return for results and any additional care needed based on the findings.
• Billing Statement: A summary of charges related to the laboratory tests performed. This document outlines what services were provided and details any patient responsibility for payment.

These documents work in conjunction with the Lab Requisition form to facilitate effective communication between patients, healthcare providers, and laboratories. Together, they help ensure that patients receive the appropriate care and that all necessary information is accurately documented and processed.

• Prescription Pad: Similar to a Lab Requisition form, a prescription pad is used by healthcare providers to order medications for patients. Both documents require patient information and provider details.
• Referral Form: A referral form is used to direct patients to specialists. Like the Lab Requisition, it includes patient demographics and often requires a reason for the referral.
• Medical History Form: This form collects information about a patient's past medical history. It shares similarities with the Lab Requisition in that both are essential for accurate diagnosis and treatment.
• Insurance Claim Form: Insurance claim forms are submitted for reimbursement. They contain patient and provider information, similar to what is required on a Lab Requisition.
• Consent Form: A consent form is used to obtain permission for treatment or procedures. Both documents require patient signatures and include essential details about the patient.
• Patient Registration Form: This form gathers demographic and insurance information from new patients. Like the Lab Requisition, it is crucial for establishing a patient-provider relationship.
• Discharge Summary: A discharge summary provides a recap of a patient’s hospital stay. It includes patient information and treatment details, similar to the information on a Lab Requisition.
• Clinical Trial Enrollment Form: This form is used to enroll patients in clinical trials. Both documents require detailed patient information and often involve specific tests or procedures.
• Progress Notes: Progress notes document a patient’s treatment over time. They include patient details and treatment plans, much like the Lab Requisition outlines tests to be performed.
• Lab Test Results Report: This report communicates the findings of lab tests. It is similar to the Lab Requisition in that both involve laboratory services and patient-specific information.

When filling out the Lab Requisition form, it is crucial to ensure accuracy and completeness. Here’s a list of things to do and avoid:

• Do fill in all required fields completely, including the provider's name, address, and contact information.
• Do specify the correct ICD 9 diagnosis code(s) to ensure proper billing and coverage.
• Do indicate the patient's gender and date of birth accurately to avoid any identification issues.
• Do check the appropriate test options and any special instructions such as fasting or STAT requests.
• Do sign and date the form to validate the request and confirm that the tests are approved by the attending physician.

• Don't leave any required fields blank, as this may delay processing or lead to unnecessary complications.
• Don't forget to specify the draw site and number of sticks if applicable; this information can be crucial for the lab staff.
• Don't use outdated or incorrect codes, as this can lead to claim denials or delays in patient care.
• Don't submit the form without double-checking for errors; even small mistakes can cause significant issues in test results and billing.

By following these guidelines, you can help ensure that the laboratory processes the requisition smoothly and efficiently.

Understanding the Lab Requisition form is crucial for both healthcare providers and patients. However, several misconceptions can lead to confusion. Here are five common misconceptions explained:

• All fields on the form are optional. Many people believe that they can skip filling out certain sections. In reality, providing complete information is essential for accurate testing and billing.
• Medicare covers all lab tests. A common misunderstanding is that Medicare will pay for every test requested. However, Medicare does not typically cover routine screening tests, which can result in unexpected costs for patients.
• Fasting is not necessary for all tests. Some individuals think that fasting is optional for all lab tests. This is not true. Certain tests, like blood glucose levels, require fasting to ensure accurate results.
• Any healthcare provider can sign the requisition. It is often assumed that any staff member can complete and sign the requisition form. In fact, only the attending physician can authorize the tests listed on the form.
• Specimens can be dropped off at any location. Many patients believe they can submit their specimens at any facility. However, specimens must be taken to designated Kaiser Permanente lab locations, and no specimens are accepted at other facilities.

Being aware of these misconceptions can help streamline the lab testing process and ensure that patients receive the care they need without unnecessary delays or complications.

• Ensure all required fields are completed on the Lab Requisition form. This includes the provider's information, patient details, and the specific tests being ordered. Missing information can lead to delays in processing.

• Be aware that certain tests may not be covered by Medicare, particularly routine screenings. It is important to fill in the appropriate ICD 9 diagnosis codes to justify the tests being ordered.

• Indicate the patient's status clearly, whether they are fasting or non-fasting, and specify any urgency such as STAT or ASAP. This helps the laboratory prioritize the tests accordingly.

• After completing the form, fax it to the designated number provided. Remember to keep a copy for your records and ensure that the form is signed and dated by the provider.