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Order Quest Diagnostics Template

The Order Quest Diagnostics form is a comprehensive document designed for healthcare professionals to submit requests for various laboratory tests provided by Quest Diagnostics. It includes detailed sections for patient information, the ordering physician's details, insurance coverage, and the specific tests requested along with sample types. This form ensures that all necessary data are captured accurately to proceed with the diagnostic services. To ease the process of requesting diagnostic tests, fill out the form by clicking the button below.

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Table of Contents

Efficiency and accuracy in patient diagnosis and treatment are of paramount importance in the medical field. The Order Quest Diagnostics form stands as a valuable instrument in this process, facilitating a streamlined method for healthcare professionals to request a variety of diagnostic tests. Located at 10 Upper Wimpole Street, London, W1G 6LL, Quest Diagnostics requires specific information for processing any request, including but not limited to the patient's surname, the ordering physician's details, patient demographics like date of birth and sex, as well as details concerning the test(s) ordered such as fasting status and whether the patient is pregnant. A unique account code, provided by Quest Diagnostics, ensures the form is correctly associated with the medical practice or physician making the request. Additional details such as insurance information and preference for receiving the report (telephone, facsimile, or patient delivery) are also integral parts of this form. The comprehensive options for clinical details and tests available, ranging from biochemistry profiles to immunology and hepatitis B immunity checks, highlight the form's versatility in serving diverse diagnostic needs. This meticulous approach aids in ensuring that all relevant details are captured at the outset, thus smoothing the path for prompt and precise diagnostic service delivery.

Form Preview

Surname:

Quest Diagnostics

10 Upper Wimpole Street

London, W1G 6LL

Account Code:

provided by Quest Diagnostics

Ordering Physician:

Forenames:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of Birth:

 

 

 

 

 

 

 

 

 

Sex:

 

 

 

 

 

 

 

day

month

year

 

 

 

Male

Female

Ethnic Origin:

 

Office / Patient number:

 

Fasting:

 

Pregnant:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Additional Physician:

Send duplicate report copy to:

Physician's Address: Required if no account code indicated

Address Line # 1

Patient's title:

Mr / Mrs / Dr / Prof / etc

Date collected:

day month year

Time collected: (24 hour clock)

hour minute

Fees to be paid by:

 

 

Doctor

Patient

 

Insurance Company

Other

 

 

details below

INSURANCE REFERENCE

Address Line # 2

Address Line # 3

Address Line # 4

Reports by:

Telephone: code number

Facsimile: code number

Patient Address: only required if patient is receiving invoice

Address Line # 1

Address Line # 2

Address Line # 3

Address Line # 4

Clinical Details:

Short Biochemistry

(QDL1)

Comprehensive Profile

(QDL5)

Lipid Profile

(QDL9)

SST

 

SST, Lavender, ESR

 

SST

 

Full Biochemistry

 

 

 

(QDL2)

Haematology Profile

(QDL6)

Hepatic Profile

(QDL10)

SST

 

 

 

 

 

 

Short Biochemistry

 

Lavender, ESR

 

SST

 

 

 

 

 

 

plus Haematology

(QDL3)

Thyroid Profile 1

(QDL7)

Immunology Profile

(QDL11)

SST, Lavender, ESR

 

SST

 

ESR, Lavender, SST

 

 

 

 

 

Full Biochemistry

 

Thyroid Profile 2

(QDL8)

MSU Profile

(QDL12)

plus Haematology

 

(QDL4)

SST

 

Mid Stream Urine

 

SST, Lavender, ESR

 

 

 

 

 

 

 

 

 

 

 

 

 

 

FRM.UWS.2401.H07.3

FBC

 

 

(Lav)

Coagulation

 

(Light Blue)

PT & APTT

 

 

 

ertert

 

 

 

U & E

 

 

(SST)

Cardiac Enzyme

 

 

(SST)

Autoantibodies

 

 

(SST)

PSA

 

 

(SST)

PSA, free PSA ratio

 

(SST)

HIV screen

 

 

(SST)

Hepatitis B surface Ag

(SST)

Hepatitis B immunity

 

(SST)

ThinPrep

(ThinPrep Vial)

Pap smear

 

 

(Slide)

 

 

 

 

Other Tests:

Sample Type:

Source:

 

 

 

 

 

 

 

 

 

 

Reason for Smear:

 

 

 

LMP (1st DAY):

 

LAST TEST:

 

 

Pregnant: Y / N

IUCD Fitted: Y / N

Post Natal: Y / N

Taking Hormones: Y / N

 

 

 

 

 

 

 

 

 

 

Office use only - do not write here

 

 

 

 

 

 

 

 

70002 RF02050/1

FOR LAB USE ONLY

 

 

RECEIPT OF SPECIMEN

 

OTHERS

 

 

 

 

 

 

 

 

EDTA

SST

GREY

MSU

TIME IN (R)

TIME IN PHL

TIME OUT PHL

 

 

 

 

 

 

 

 

 

 

 

 

 

Form Breakdown

Fact Name Description
Form Identifier The form is identified as FRM.UWS.2401.H07.3, designated for use by Quest Diagnostics.
Personal Information Collection Collects detailed patient information including name, contact details, date of birth, sex, ethnic origin, and insurance reference.
Physician Information Requires details of the ordering physician, additional physician (if applicable), and options to send duplicate report copies to another physician.
Diagnostic Test Options Offers a wide range of tests including biochemistry profiles, haematology profiles, liver profiles, thyroid profiles, immunology profiles, and specific tests like HIV screen and PSA.
Governing Laws While this form is for Quest Diagnostics' London location, it's important to note that specific tests and report handling might be subject to UK health regulatory laws and patient privacy legislation.

Guidelines on Filling in Order Quest Diagnostics

Getting your medical tests done through Quest Diagnostics can feel like navigating through a maze. Filling out an order form correctly ensures that your tests are processed efficiently and accurately. It's about making your visit smoother and your healthcare professional's job easier. Whether you're a patient or a doctor, following these steps will guide you in completing the Quest Diagnostics order form without any hassle.

  1. Start with the basics: Enter the 'Surname' as "Quest Diagnostics" and the location "10 Upper Wimpole Street London, W1G 6LL" into the designated spots on your form.
  2. Account Code: Fill in the 'Account Code' box with the code provided by Quest Diagnostics.
  3. Physician Information: In 'Ordering Physician,' write down the forenames, surname, and contact details of the physician who is ordering the tests.
  4. Patient Information: Enter the patient's title (Mr, Mrs, Dr, etc.), surname, forename, date of birth, sex, and ethnic origin. Add the office or patient number if known. Specify if the patient is fasting, pregnant, and if any additional physician should receive the report.
  5. Physician's Address: Fill in the physician's address fields with the appropriate address. This is required if no account code is indicated.
  6. Sample Collection Details: Record the 'Date collected' and 'Time collected' using the 24-hour clock format.
  7. Payment Information: Indicate who will be responsible for the fees - Doctor, Patient, Insurance Company or Other.
  8. Insurance Details: If applicable, provide the 'Insurance Reference' and complete the additional address lines for insurance purposes.
  9. Communication Preferences: Choose how you would like to receive reports - via telephone or facsimile, including the relevant codes and numbers. If the patient is to receive the invoice, fill out the 'Patient Address' section.
  10. Clinical Details and Tests: Mark the appropriate boxes for the required tests, such as 'Short Biochemistry,' 'Comprehensive Profile,' 'Lipid Profile,' and others as needed. Include details about the sample type, source, reason for smear, and any relevant dates such as 'LMP (1st DAY)' or 'LAST TEST.'
  11. Other Tests: If you require tests that are not listed, use the 'Other Tests' field to specify them.
  12. Pregnancy and Hormone Information: Indicate if the patient is pregnant, has an IUCD fitted, is postnatal, or is taking hormones with a simple 'Yes' or 'No.'
  13. Finally, remember this section is for Office use only - don't write anything in the 'FOR LAB USE ONLY' box at the bottom of the form. It's reserved for Quest Diagnostics staff.

By carefully going step-by-step, you ensure that your form is filled out correctly, which is vital for accurate and timely processing of your lab tests. Remember, these details help your healthcare provider get the information they need to support your health best. If you have any uncertainties, don't hesitate to ask your doctor or reach out to Quest Diagnostics directly for guidance.

Learn More on Order Quest Diagnostics

What is the purpose of the Order Quest Diagnostics form?

This form is used to order various diagnostic tests from Quest Diagnostics, a leading laboratory services provider. It captures detailed information such as patient demographics, the ordering physician, the type of tests needed, billing information, and how results should be delivered. Its purpose is to ensure that the correct tests are performed and that the results are sent to the appropriate healthcare provider efficiently.

Who needs to fill out this form?

The ordering physician or a designated healthcare provider fills out the form. It's their responsibility to provide accurate and comprehensive information about the patient, the tests required, and billing details. In some instances, office staff may assist in completing the form but under the supervision of a healthcare provider.

How should the form be filled out?

  1. Start with the patient's surname and the provided "Account Code" from Quest Diagnostics.
  2. Fill in the ordering physician's details, including forenames and contact information.
  3. Complete the patient's information section, including their date of birth, sex, ethnic origin, and office/patient number.
  4. Indicate whether the patient is fasting, pregnant, or requires a duplicate report to be sent to another physician.
  5. Specify who will pay the fees: Doctor, Patient, Insurance Company, or others.
  6. Choose the tests needed by selecting from the clinical details section.
  7. Provide insurance details, including the insurance reference and address.
  8. Determine how you would like to receive the reports, via telephone, facsimile, or patient address if the patient is receiving the invoice.

What types of tests can be ordered with this form?

Several types of tests can be ordered, including but not limited to:

  • Biochemistry profiles (Short, Full, Comprehensive)
  • Haematology profiles
  • Lipid and Hepatic profiles
  • Thyroid profiles
  • Immunology profiles
  • MSU profile and Coagulation tests
  • Cardiac enzymes, Autoantibodies, PSA tests, HIV screen, and Hepatitis B tests
  • Pap smear and other cytology tests

What does "Fees to be paid by" mean?

This section specifies who will bear the costs of the ordered tests. It can be the Doctor, Patient, Insurance Company, or another specified entity. This information ensures that billing and payment are handled correctly.

What details are required under "Insurance Reference"?

When the insurance company is footing the bill, this section requires you to input the insurance reference number and the address of the insurance company. This ensures that the insurance company is accurately billed for the services provided.

How are test results delivered?

Test results can be delivered in a handful of ways as indicated on the form:

  • Telephone: Results are communicated over the phone to a specified number.
  • Facsimile: Results are faxed to a provided fax number.
  • Patient Address: If the patient opts to receive the invoice, results can be sent directly to the patient's address.

What should one do if they need assistance filling out the form?

If assistance is needed when completing the Order Quest Diagnostics form, it is advisable to contact Quest Diagnostics directly. They can provide guidance and answer any specific questions related to the form or the ordering of diagnostic tests.

Common mistakes

When filling out the Order Quest Diagnostics form, it is crucial to ensure accuracy and completeness to avoid any delays or issues with the tests ordered. However, mistakes can sometimes occur, some of which are more common than others. Below are nine mistakes frequently made:

  1. Incorrect or incomplete surname information: Forgetting to fill in the surname field or mistakenly entering partial names can lead to significant confusion and misidentification.
  2. Failing to provide the Account Code: The Account Code is a critical piece of information provided by Quest Diagnostics, necessary to process your request efficiently. Not including this may result in delays.
  3. Omitting the Ordering Physician’s Forenames: The doctor's full name ensures the results are sent to the correct medical professional for review. Inputting only initials or a partial name can lead to misunderstandings.
  4. Error in Date of Birth: Incorrect dates, either by day, month, or year, can misclassify the patient's age and potentially impact the interpretation of test results.
  5. Incorrect Sex indication: This is crucial for the interpretation of many tests, as normal ranges can differ between males and females.
  6. Neglecting to indicate Fasting status: For some tests, fasting is required to get accurate results. Not specifying this can affect test outcomes.
  7. Leaving the Pregnant status ambiguous: Knowing whether a patient is pregnant is essential for correctly interpreting certain test results.
  8. Incomplete Physician's Address: This is crucial when an Account Code is not provided. An incomplete address can delay the delivery of test results.
  9. Miscommunication of how fees are to be paid (Doctor, Patient, Insurance Company): A clear understanding of who is responsible for the payment is necessary to process the order without any financial misunderstandings.

In addition to these common errors, it is important to remember:

  • Always double-check information before submitting the form to reduce the risk of mistakes.
  • Ensure all required fields are completed to avoid unnecessary delays.
  • Communicate clearly and provide detailed information wherever necessary to ensure accurate processing of your order.

The attention to detail can significantly impact the efficiency and accuracy of the diagnostic process, ultimately affecting patient care. Properly filled forms also help in maintaining a smooth operation within Quest Diagnostics and ensure timely reporting of test results to the concerned parties.

Documents used along the form

When submitting an Order Quest Diagnostics form, it is not uncommon to include additional documents to ensure a comprehensive understanding of the patient's health profile and streamline the diagnostic process. Here are four other forms and documents often used together with the Order Quest Diagnostics form, each serving a unique yet complementary purpose.

  • Patient Consent Form: This document is crucial as it records the patient’s authorization for the laboratory tests to be performed and their consent to share the results with designated medical professionals. It also typically includes a section on the patient’s consent regarding the use of their medical information for research or educational purposes.
  • Insurance Information Form: This form gathers details about the patient’s health insurance coverage. It includes the insurance provider's name, policy number, and the policy holder's information, necessary for billing purposes and determining coverage for the requested diagnostic tests.
  • Physician's Referral: Often, tests are requested based on a physician's referral. This document outlines the medical necessity for the requested diagnostics, providing insights into the patient's current symptoms, potential diagnoses, or the need for the test as part of an ongoing treatment plan. It serves as a critical communication tool between the physician and the diagnostic lab.
  • Medical History Form: This extensive document provides a comprehensive view of the patient’s medical history, including previous illnesses, surgeries, ongoing treatments, and familial medical conditions. This background can help in interpreting the test results more accurately and may influence the type or extent of diagnostics performed.

Incorporating these documents with the Order Quest Diagnostics form ensures a smoother operational flow, from processing the test request to conducting the tests and interpreting the results. Collectively, they provide a holistic view of the patient's health status, ensuring that both the healthcare providers and the diagnostic professionals have the necessary information to proceed with the appropriate care and treatments.

Similar forms

  • Prescription Form: Similar to the Order Quest Diagnostics form, a prescription form also collects essential patient information such as name, date of birth, and specific requests from the physician—like the type of medication needed. Both documents serve as instructions from healthcare professionals to other entities, ensuring that patients receive the appropriate care or service.

  • Medical Test Requisition Form: This form is very similar because it's used by healthcare professionals to request certain lab tests. It includes specific details about the patient—like Quest Diagnostics form does—such as name, age, and tests requested. Both forms are integral in the process of diagnosing and monitoring conditions through laboratory testing.

  • Referral Form: When a healthcare provider refers a patient to a specialist or another clinic, they use a referral form. Like the form by Quest Diagnostics, it contains patient information, the referring physician's details, and the reason for referral. The purpose of both documents is to ensure continuity of care between different health care providers.

  • Health Insurance Claim Form: This form is used by or on behalf of patients to claim reimbursement from their health insurance for the services obtained. It resembles the Quest Diagnostics form in capturing patient details, insurance information, and specifics about the medical services provided or requested, facilitating the financial transactions involved in healthcare.

  • Patient Registration Form: Often used when a patient first visits a medical practice, this form collects comprehensive personal and medical history information. Like the Order Quest Diagnostics form, it includes patient demographics, contact information, and insurance details, though its scope is broader, serving as an initial record in the patient's medical file.

Dos and Don'ts

When filling out the Order Quest Diagnostics form, it's important to follow specific dos and don'ts to ensure the accuracy and efficiency of your submission. Keep these guidelines in mind:

Do:
  • Double-check the account code provided by Quest Diagnostics for accuracy to ensure proper billing and communication.
  • Provide complete information for the Ordering Physician, including forenames and contact details, to avoid any confusion or delays.
  • Clearly indicate the patient's date of birth, sex, and ethnic origin, as these details are crucial for accurate test results and interpretations.
  • Specify if the patient is fasting, pregnant, or has any other condition that might affect the test results or require special attention.
  • Include detailed insurance reference and patient address if the patient is receiving the invoice, to ensure smooth processing and payment.
  • Clarify who will be responsible for the fees (Doctor, Patient, Insurance Company, etc.), to prevent billing issues.
  • Select the correct tests and sample types needed, as incorrect selections can lead to the need for retesting and delayed diagnoses.
  • Enter the date and time of sample collection accurately to maintain the integrity of the samples and test results.
  • Provide an additional physician's details if a duplicate report is needed elsewhere, ensuring all relevant parties are informed.
  • Review all sections carefully before submission to ensure all necessary information has been provided and is accurate.
Don't:
  • Leave any required fields blank, as missing information can delay processing and result in errors.
  • Guess on any information; verify all details if uncertain, to avoid inaccuracies in the patient's medical records.
  • Use nicknames or abbreviations for the patient's title or name; use the full legal name and appropriate title to prevent misidentification.
  • Forget to specify if sending a duplicate report copy to an additional physician; this oversight can result in incomplete communication among healthcare providers.
  • Neglect to indicate the patient's pregnancy status, fasting status, or other relevant conditions, as these can significantly affect test outcomes.
  • Overlook the importance of specifying the sample type correctly; this can lead to the necessity of resampling and delays in diagnosis.
  • Use outdated contact information for the ordering physician or patient; up-to-date information is crucial for prompt reporting and billing.
  • Assume the insurance will cover all tests without verifying coverage, to avoid unexpected bills.
  • Omit the reason for the test or sample being taken when applicable, as it helps the laboratory prioritize and understand the context of the analysis.
  • Disregard signing and dating the form where required, as an unsigned form may not be processed.

Misconceptions

When discussing the Order Quest Diagnostics form, several misconceptions often emerge, leading to confusion and inaccuracies. Let's tackle some of these misunderstandings to clarify the process and ensure that both patients and practitioners navigate the form with confidence.
  • Every field must be filled for every patient: Not all sections of the form need to be completed for every order. Mandatory fields are usually marked, and filling only the relevant sections based on the specific tests ordered and the billing requirements is essential. For instance, "Pregnant" is only applicable if relevant to the patient's current state and the tests ordered.

  • The form is only for use within the United Kingdom: While the provided address is in London, Quest Diagnostics operates globally. The form or its equivalent is used in various countries where Quest Diagnostics offers its services, but with localized details as necessary.

  • Insurance details are optional: If the insurance company is covering the cost of testing, providing insurance details is crucial. This section cannot be overlooked as it determines who will be billed and how the billing process will be managed.

  • Test results can only be sent to the ordering physician: The form allows for results to be sent to an additional physician. This flexibility ensures that all relevant parties involved in a patient's care can access the necessary information efficiently.

  • A patient’s email address can be used for receiving results: Currently, the form specifies reports by telephone or facsimile. Although Quest Diagnostics may offer electronic delivery, the form outlines traditional methods, reaffirming the need to specify how results should be dispatched correctly according to the form's current setup.

  • Ethnic origin details are mandatory for test processing: While providing ethnic origin can be valuable in some medical contexts, it is generally not a requirement for test processing. This information is more about ensuring comprehensive patient records and tailoring care as needed rather than being a mandatory test processing detail.

  • Office use and lab use sections can be filled out as needed: These sections are reserved for Quest Diagnostics staff only and should not be completed by the ordering physician or the patient. They are used internally for tracking and processing the specimen once received in the lab.

  • All tests require fasting: While certain tests might require fasting to ensure accuracy, not every test listed on the form requires it. This misconception could lead to unnecessary inconvenience for patients. Therefore, indicating whether a patient needs to fast is specific to the test and should be communicated clearly.

Understanding these details can smooth the process for both healthcare providers and patients, ensuring test orders are completed accurately and efficiently.

Key takeaways

When you're filling out the Order Quest Diagnostics form, it's essential to pay attention to specific details to ensure that your test request is processed efficiently and accurately. Here's what you should keep in mind:

  • Complete all personal information accurately. This includes the patient's surname, forenames, date of birth, sex, ethnic origin, and patient number. Correct information ensures that your test results are matched to the right person.
  • Include the requesting physician's details. The ordering physician's name and any additional physician who will receive a duplicate report should be clearly stated. This is crucial for proper communication and follow-up.
  • Specify the account code if available. If Quest Diagnostics has provided an account code, include it on the form. It helps in processing the order under the right account and might be necessary for billing purposes.
  • Fill out the test request section comprehensively. Choose from the listed tests, like biochemistry profiles, lipid profiles, and haematology profiles, to specify what tests are required. Your clear selection helps the laboratory process your request correctly.
  • Indicate any relevant patient conditions. Information about fasting, pregnancy, or if a patient is postnatal, using an IUCD, or taking hormones, provides essential context for interpreting test results.
  • Detail how the fees will be paid. It's important to state whether the doctor, patient, insurance company, or another party will be covering the fees, including the insurance reference if applicable.
  • Choose the preferred method for reporting the results. Whether you opt for a report by telephone, facsimile, or another method, specifying this guarantees that the results are communicated through your preferred channel.
  • Provide clear collection details. Including the date and time of the sample collection helps in maintaining the integrity of the test results.
  • Signify sample type and details where necessary. For certain tests, such as pap smears or specific blood tests, detailing the sample type, source, and reason for the test contributes to accurate test analysis and reporting.

By carefully completing each section of the Order Quest Diagnostics form, you support a smooth process for both the laboratory and all individuals involved, ensuring that test results are accurate, timely, and appropriately reported. Remember, accurate and complete information is key to getting the reliable services you expect from Quest Diagnostics.

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