Lab Requisition Template

Guidelines on Filling in Lab Requisition

Once a healthcare professional has decided to proceed with laboratory testing, the next step involves correctly filling out the Lab Requisition form. This document is crucial for ensuring the lab technicians have all the necessary information to process the samples accurately and return reliable results. Here's how to fill it out:

1. Start by entering the UPIN / NPI number of the provider at the top of the form.
2. Fill in the Provider's Name and Address, including the Phone Number and Secure Fax Number.
3. Enter the patient's last and first name, along with their Kaiser Medical Record Number if available.
4. Mark the patient's gender by checking either Male or Female.
5. Write the patient's Date of Birth.
6. Specify if the sample is NON-FASTING, FASTING (including the number of fasting hours), STAT, or ASAP.
7. Under the required section, enter the ICD 9 Diagnosis Code(s).
8. Select the tests needed from the provided categories (Urinalysis, Hematology, Coagulation, Chemistry Profiles, Chemistry Single Tests, Therapeutic Drugs, Special Chemistry, Other Testing, 24 Hour Urine Tests).
9. If applicable, note the Date and Time of the Last Dose for therapeutic drug monitoring.
10. For tests that offer options (PEAK / TROUGH), make sure to specify by checking the appropriate box.
11. At the bottom of the form, provide details about the Draw Site, the number of sticks attempted, and whether the patient was unable to be drawn.
12. Indicate whether the physician was notified with a YES or NO.
13. Check the types of specimen containers needed (SST, Lavender, Red, Blue, Green, Gray, Urine, Stool, Swab).
14. Write any comments or special instructions in the provided space.
15. Ensure the attending physician signs and dates the form.
16. Fax the signed and dated form to the specified number.

After completing these steps, make sure to double-check the form for accuracy and completeness. This will help avoid any delays in processing. Once you fax the form to the lab, they will prepare for the tests ordered. Remember, if there's a need for any additional tests not listed on the form, the provider must call the number provided to make those arrangements.

What is a Lab Requisition Form?

A Lab Requisition Form is a document used by healthcare providers to request specific laboratory tests for their patients. It includes important information such as the patient’s name, date of birth, the tests ordered, and the provider's contact details. This form is essential for ensuring the correct tests are performed and that the results are accurately reported back to the ordering physician.

Who fills out the Lab Requisition Form?

The healthcare provider who is requesting the laboratory tests for the patient fills out the Lab Requisition Form. This could be a doctor, nurse, or other healthcare professional responsible for the patient’s care. The form must be completed with accurate patient information and specific details about the tests being requested.

What information is required on the Lab Requisition Form?

The form requires several pieces of information, including:

• The provider’s name, address, phone number, and secure fax number
• The patient’s name, date of birth, and sex
• Applicable diagnosis codes (ICD 9 diagnosis codes)
• Details of the tests being requested (e.g., hematology, chemistry profiles, urinalysis)
• Additional instructions such as fasting requirements and whether the test is routine, ASAP, or STAT

How do I submit a Lab Requisition Form?

Once the Lab Requisition Form is filled out, it should be faxed to the designated number provided by the laboratory. For Kaiser Permanente, the fax number is 303-404-4030. Ensure that the form is signed and dated before faxing.

Are there any special instructions for filling out the Lab Requisition Form?

Yes, it’s important to:

1. Clearly indicate if the test is fasting, non-fasting, routine, ASAP, or STAT.
2. Fill in all requested information thoroughly to prevent delays.
3. Include specific instructions for the laboratory, if necessary, in the comments section.

What if I need to order a test that is not listed on the form?

If the test you need to order is not listed on the Lab Requisition Form, you must call the number provided for ordering other tests. For Kaiser Permanente, the phone number is 303-743-5330.

Can I pick up 24-hour urine containers at any laboratory location?

Yes, 24-hour urine containers can be picked up at any Kaiser Permanente laboratory location. There is no need to make an appointment for routine laboratory testing, but keep in mind that no specimens will be accepted without a completed Lab Requisition Form.

Who do I contact if I have questions about specimen collection or the Lab Requisition Form?

If you have questions regarding specimen collection or the Lab Requisition Form, you should contact the Laboratory Client Services Department. For Kaiser Permanente, the number to call is 303-404-4050, available Monday to Friday, 8 am to 6 pm.

1. One common mistake is omitting the UPIN/NPI number, which is crucial for identifying the healthcare provider within the medical system. This omission can lead to delays in processing the lab requisition.

2. Another error involves incomplete provider information, including name and contact details. This information is essential for any necessary follow-up or clarification regarding the lab request.

3. Failing to provide accurate patient information, such as the patient's name, date of birth, and Kaiser Medical Record number. This accuracy is critical for ensuring that the test results are correctly attributed to the patient.

4. Incorrectly marking the patient's sex can affect the interpretation of certain test results, as reference ranges may differ between males and females.

5. Not specifying ICD 9 DIAGNOSIS CODE(s) is a significant oversight, especially since Medicare does not generally cover routine screening tests without a proper diagnosis code.

6. Overlooking the importance of indicating whether a test is to be done on a fasting basis or not. This information can drastically impact the results and interpretation of tests such as glucose and lipid profiles.

7. Leaving the test selection area incomplete or marking it inaccurately. Each test requested must be clearly indicated for the lab to process the requisition correctly.

8. Forgetting to mark the urgency of the test, such as STAT, ASAP, or routing, which instructs the lab on how quickly the tests should be processed.

9. Failure to sign and date the form. The provider's signature and the date validate the form, authorizing the lab to proceed with the requested tests. Without this, the requisition may not be processed.

10. Neglecting to specify the draw site and number of sticks, especially in complex cases where multiple samples may be needed. This information helps in planning and executing the sample collection efficiently.

In summary, careful attention to detail in filling out every section of the Lab Requisition form is crucial. Mistakes or omissions can lead to delays in testing, impact the accuracy of the test results, or even necessitate re-collection of specimens, causing inconvenience to the patient and potentially delaying diagnosis and treatment.

When a patient undergoes medical testing, multiple forms and documents are often needed along with the Lab Requisition form to ensure that the tests are carried out efficiently and the results are accurately reported. These accompanying documents serve various purposes, such as providing additional information on the patient's medical history, specifying the tests to be performed, or ensuring compliance with insurance and legal requirements. Here is a list of other forms and documents that are frequently used in conjunction with the Lab Requisition form:

• Patient Consent Forms: These are used to obtain the patient’s consent for the specific laboratory tests to be conducted, ensuring they are aware and agreeable to the procedures and their implications.
• Medical History Forms: These documents gather comprehensive information about the patient's medical history, allergies, and medications, which might be relevant to the laboratory tests and their interpretation.
• Insurance Information Forms: These forms collect details regarding the patient’s health insurance to facilitate billing and verify coverage for the requested laboratory tests.
• Physician’s Orders: This document details the specific tests or procedures ordered by a physician that are not covered in the standard Lab Requisition form, providing clear instructions and authorization for additional testing.
• Advanced Beneficiary Notice (ABN): For patients covered by Medicare, this form notifies them of tests that Medicare might not cover, and the patient’s acceptance of financial responsibility for these tests if Medicare does not pay.
• Specimen Labels: These are used to ensure accurate labeling of specimens with the patient’s information, test type, and other relevant data, reducing the risk of specimen mix-up or loss.
• Test Result Release Forms: These authorize the laboratory or the ordering physician to release test results to the patient, another healthcare provider, or a designated representative, in compliance with privacy regulations.
• Quality Control Documents: Used internally by the laboratory, these documents record the performance of testing equipment and the quality control measures taken to ensure the accuracy and reliability of test results.

Understanding the purpose and requirements of each form and document associated with the Lab Requisition enhances the efficiency, accuracy, and legal compliance of the laboratory testing process. Proper management of these documents supports better communication between healthcare providers, laboratories, and patients, ultimately contributing to higher quality patient care.

• Prescription Forms - Much like lab requisition forms, prescription forms are used by healthcare providers to order medication for their patients. They require the patient's name, medication details, dosage instructions, and the prescribing physician's information, mirroring the requirement on laboratory requisition forms for detailed patient information, specific tests to be conducted, and physician details.

• Medical Referral Forms - These forms are used by doctors to refer patients to specialists. Similar to lab requisition forms, they include the patient’s personal information, the referring physician’s details, and the purpose of the referral, aligning with the lab requisition form’s inclusion of patient data, provider information, and specific tests needed for diagnosis or treatment assessment.

• Patient Registration Forms - When patients visit a new healthcare provider or facility, they often fill out registration forms that gather their personal and insurance information. Like lab requisition forms, these documents collect comprehensive details about the patient, although for administrative rather than diagnostic purposes.

• Insurance Claim Forms - These forms are submitted to insurance companies for the reimbursement of healthcare expenses. They require detailed information similar to lab requisition forms, such as patient information, provider details, and services rendered, albeit with a focus on financial rather than clinical data.

• Consent Forms for Medical Procedures - Before undergoing certain medical procedures, patients must sign consent forms that explain the risks and benefits. These documents, while more focused on legal permissions, similarly require detailed patient information, a clear description of the procedure (akin to the test descriptions in lab requisitions), and the authorization signature of the patient or legal guardian, paralleling the provider’s signature on the lab requisition form.

When filling out a Lab Requisition form, there are specific steps that should be followed for accurate test ordering and processing. Below are the things you should and shouldn't do:

• Verify patient information: Double-check to ensure the patient's name, date of birth, and any identification number are correctly entered.
• Use legible handwriting: To avoid misinterpretation, write clearly if the form is filled out manually.
• Include all necessary details: Fill in every section that is applicable, including the test orders, diagnosis codes, patient demographics, and provider information.
• Specify fasting status: Indicate whether the patient is fasting, non-fasting, or if there are specific requirements for the test.
• Choose the correct test codes: Ensure the correct ICD 9 diagnosis codes and test codes are selected to match the patient's condition.
• Sign and date the form: Confirm the requisition with the provider's signature and the date to validate the request.
• Provide contact information: Include the provider's phone number and secure fax number for any follow-up or clarification.
• Indicate urgency: Clearly mark if the test is routine, STAT, ASAP, or requires specific timing for best patient care.
• Use the appropriate boxes: For selections like gender, test types, or specimen types, mark the relevant box clearly.
• Include time of last dose for therapeutic drugs: If ordering drug level testing, note the date and time of the last dose for accuracy.

• Leave required fields empty: Missing information can delay processing and affect the test outcome.
• Assume routine tests are covered: Be aware that Medicare does not generally cover routine screening tests without a qualifying diagnosis.
• Use non-standard abbreviations: Stick to accepted medical and laboratory abbreviations to avoid confusion.
• Forget to indicate specimen type: Specify if you need blood, urine, stool, or another type of specimen to ensure correct collection.
• Omit testing priority: Without stating whether the test is STAT, ASAP, or routine, the lab may process it as standard routine.
• Overwrite or use correction fluid: Mistakes can lead to misinterpretation; if an error is made, it's best to start on a new form.
• Ignore special instructions: If there are specific collection or handling instructions, make sure these are noted for the laboratory.
• Order tests without clinical justification: Ensure tests are medically necessary and backed by appropriate diagnosis codes.
• Send incomplete requisitions: A form missing the provider's signature or other key details can lead to testing delays or cancellation.
• Neglect to confirm receipt: After faxing or submitting the form electronically, verify that the laboratory has received it.

When looking at a Lab Requisition form, it's easy to misunderstand its purpose and the information it requires. Below are six common misconceptions that can lead to confusion:

• All laboratory tests are covered by Medicare. Many people believe that Medicare will cover any lab test as long as it's requested by a doctor. However, the truth is, Medicare does not generally cover routine screening tests. It's essential to check coverage to avoid unexpected bills.

• The requisition form is for the physician's use only. While it's true that healthcare providers fill out the form, understanding the requisition process can empower patients. It can aid in discussions with your healthcare provider about the tests ordered and your understanding of your health care.

• If you don’t understand a test, it’s probably not important. Every test ordered serves a purpose. If there's confusion about why a test has been requested, it's beneficial to ask for clarification. Knowing what each test is for can help you be more informed about your health.

• Completing the form partially is okay as long as the test name is clear. A lab requisition form requires complete and accurate information to process the tests correctly. Missing information can lead to delays or errors in testing.

• It doesn’t matter which laboratory the tests are sent to. Different laboratories might have varying abilities to conduct certain tests, and in some cases, your insurance may only cover tests performed at specific laboratories. Always verify where your tests should be sent.

• The form is only valid at the issuing physician's office or network. This form, particularly if it's a standardized form like the one from Kaiser Permanente, can often be used at any location within the specified network, not just at the issuing office. However, it's essential to confirm with your healthcare provider or the lab itself.

Addressing these misconceptions can help ensure that lab tests are completed smoothly and efficiently, leading to better health outcomes. Remember, communication is key. If there's ever any doubt or confusion, asking questions can clear up misunderstandings and provide a clearer path forward.

When it comes to filling out and utilizing the Lab Requisition form, there are several key takeaways to ensure the process is done accurately and efficiently. Understanding these points can help streamline submissions, avoid delays, and ensure that patients receive the most appropriate care based on their test results.

• Complete provider information is crucial. This includes the UPIN/NPI number, provider name, address, phone number, and secure fax number. Accurately filling out this section ensures the lab knows who is requesting the tests and where to send the results.
• Patient identification needs meticulous attention. Details such as the patient's name, date of birth, and, if applicable, Kaiser Medical Record Number, are essential for correctly associating the lab results with the right patient.
• The ICD 9 diagnosis codes section is labeled as "Required" because Medicare and other insurers often use these codes to determine the necessity and coverage for the tests. Including accurate diagnosis codes can help prevent issues with insurance coverage.
• Indications about the patient's fasting status and whether the test needs to be expedited (marked as STAT or ASAP) provide the lab with crucial information on how to prioritize and handle the samples upon receipt.
• Clearly marking the specific tests requested is vital. The form includes a wide variety of tests, categorized under headings such as Urinalysis, Hematology, Coagulation, Chemistry Profiles, Chemistry Single Tests, Therapeutic Drugs, Special Chemistry, Other Testing, and 24 Hour Urine Tests. Being precise helps ensure that all and only the necessary tests are performed.
• The instructions provided for the draw site, number of sticks, and tube types (SST, LAVENDER, RED, BLUE, GREEN, GRAY, URINE, STOOL, SWAB) as well as additional comments, are critical for lab technicians. These instructions assist in collecting the specimen correctly and efficiently, impacting the accuracy of the test results.

It's important to note that no specimens will be accepted at any Kaiser Permanente facility without an appointment for routine laboratory testing, except for the 24-hour urine tests where containers can be picked up at any Kaiser Permanente laboratory location without an appointment. For any tests not listed on the form, the provider must call a specific phone number to order. Moreover, ensuring the form is signed and dated by the provider and indicating whether the physician was notified if unable to draw, helps in maintaining a complete record of the patient's care journey.