Free Lab Requisition PDF Template

1. 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. This form includes essential details such as the patient's name, date of birth, tests requested, and physician's information, allowing labs to understand what tests are needed and why.

2. Who fills out the Lab Requisition Form?

   Healthcare providers, such as physicians or nurse practitioners, complete the Lab Requisition Form. It is their responsibility to accurately fill out the form with all necessary patient information and the required laboratory tests, including specifying any fasting requirements or if the test is to be taken STAT (immediately) or ASAP (as soon as possible).

3. Why is the patient's ICD 9 DIAGNOSIS CODE required?

   The ICD 9 DIAGNOSIS CODE is essential because it provides a clear reason for the requested tests, ensuring that they are medically necessary. This information is particularly vital for billing purposes and insurance claims, as Medicare and other insurance providers typically require a diagnosis code to approve and cover the cost of the tests.

4. Can routine screening tests be covered by Medicare?

   No, Medicare does not generally cover routine screening tests unless medically necessary and indicated for diagnosis or treatment of a specific condition. The form highlights this by requiring specific diagnosis codes to justify the necessity of the requested tests.

5. How should the form be submitted to the lab?

   Providers are instructed to fax this signed and dated form to the provided secure fax number. This ensures that patient information is transmitted securely and arrives promptly at the laboratory, facilitating the quick processing of test requests.

6. What does "ROUTINE versus STAT" mean on the form?

   "ROUTINE" indicates that the tests can be performed as part of the laboratory's regular testing schedule, without urgency. "STAT," on the other hand, signals that the test is urgent and must be prioritized above routine tests to rapidly assist in diagnosing or managing a condition.

7. Is fasting required for all tests requested on the form?

   Not all tests require fasting, but for those that do, it's crucial to indicate the number of fasting hours. Fasting is essential for certain blood tests to ensure accuracy, as eating can alter the levels of substances in the blood. The form allows healthcare providers to specify if the patient should be fasting and for how long before taking the test.

8. What should I do if I need a test that is not listed on the form?

   If a healthcare provider needs a test that is not specified on the form, they must call the provided number to order the test. This allows the provider to seek approval and ensure the laboratory can accommodate the request, ensuring patient needs are fully addressed.

1. Not providing the complete UPIN/NPI number can lead to processing delays as this is critical for identifying the provider.
2. Leaving the ICD 9 DIAGNOSIS CODE(s) blank is a common error, which could result in Medicare or other insurance providers denying coverage for the tests.
3. Failing to indicate patient gender and date of birth accurately. These details are essential for the correct interpretation of certain tests.
4. Omitting fasting status or incorrectly marking the fasting hours can lead to inaccurate test interpretations, especially in metabolic profiles.
5. Not specifying if the request is STAT, ASAP, or routine can cause unnecessary delays in processing the sample.
6. Incorrectly selecting test codes or leaving them blank. Each test code corresponds to a specific analysis, and mistakes here can lead to the wrong tests being performed.
7. Forgetting to sign and date the requisition form. This is a legal document, and without a signature, the lab may refuse to process the tests.
8. Lack of clarity on specimen type needed for the test (e.g., blood, urine, stool). This can lead to incorrect or insufficient samples being collected.
9. Not using the provided comments section to clarify unusual requests or elaborate on clinical context which may be crucial for accurate test interpretation.

Common mistakes can include both omissions and inaccuracies that directly impact patient care and the timely processing of lab tests. Attention to detail and thorough review before submission are crucial for avoiding these errors.

When managing patient care, healthcare providers often rely on a variety of forms and documents in addition to the Lab Requisition form. These documents ensure accurate, effective, and timely analysis and treatment, facilitating communication between medical professionals, laboratories, and insurance providers. They range from consent forms to insurance documentation, each playing a crucial role in the healthcare process.

• Patient Consent Forms - These forms document the patient's agreement to undergo the specific laboratory tests ordered, acknowledging their understanding of the procedures involved.
• Insurance Coverage Verification Forms - Essential for determining whether the patient's health insurance covers the requested lab tests, helping to avoid unexpected expenses.
• Patient History Forms - Provide comprehensive background information, including medical history, allergies, and medications, to inform appropriate test ordering and interpretation.
• Physician's Orders - Detailed instructions from the requesting physician or healthcare provider that accompany the lab requisition, specifying tests to be performed based on diagnosis and patient needs.
• Advance Beneficiary Notice (ABN) Forms - Used primarily in cases where Medicare coverage is uncertain, informing the patient that they may be responsible for the payment if Medicare does not cover the test.
• Test Results Forms - Documents where results of the lab tests are recorded, to be reviewed by the healthcare provider for diagnosis and treatment planning.
• Specimen Collection and Handling Instructions - Provide specific guidelines for collecting and storing specimens to ensure their integrity until testing, critical for accurate results.
• Health Insurance Portability and Accountability Act (HIPAA) Compliance Forms - Ensure that patient information is handled in accordance with federal privacy regulations during the lab testing process.
• Referral Forms - If specialized testing is needed that cannot be performed by the initial lab, referral forms facilitate the transfer of samples and patient information to another facility.
• Quality Control Documents - Although not seen by the patient, these internal lab documents are essential for ensuring the accuracy and reliability of test results.

In the context of healthcare, these documents, together with the Lab Requisition form, create a comprehensive workflow that supports patient diagnosis, treatment, and management. The effective use and management of these forms are key to ensuring that patients receive the most accurate and timely care possible.

• Prescription Forms: Similar to lab requisition forms, prescription forms are used by healthcare providers to request specific medications for their patients. Both contain crucial information such as the patient's name, date of birth, and specific requests (in the case of prescriptions, the medication, dosage, and frequency; in lab requisitions, the specific tests to be performed). Both forms serve as a formal request to another healthcare department to provide a specific service or product for patient care.

• Referral Forms: These forms are used by physicians to refer patients to specialists or other healthcare providers for further examination or treatment. Like lab requisition forms, referral forms include the patient's personal information, the requesting physician's details, and the purpose of the referral, akin to the lab tests being requested on a lab requisition form. Each form facilitates coordination between different healthcare sectors to address a patient's specific healthcare needs.

• Medical Records Release Forms: These forms authorize the sharing of a patient's medical information between healthcare providers or institutions. They contain patient identification details and specifications about what information can be shared, mirroring the structure of lab requisition forms, which also specify what tests are needed. Both types of documents ensure that pertinent patient information is transferred securely and accurately for continued patient care.

• Insurance Claim Forms: Used by healthcare providers or patients to request payment or reimbursement from health insurance companies. These forms share similarities with lab requisition forms, as they must include specific patient information, provider details, and the services provided (or to be provided in the case of lab requisitions) to process the claim effectively, ensuring that all necessary information is presented clearly for financial and administrative purposes.

• Consent Forms for Treatment: Prior to undergoing specific medical procedures or treatments, patients are often required to sign consent forms. These documents share the lab requisition form's requirement for detailed patient information and an explicit outline of the procedure/test to be undertaken. Essentially, both forms ensure that the patient or their guardian is fully informed and agrees to the specified medical intervention, facilitating ethical and legal compliance in patient care.

When filling out a Lab Requisition form, accuracy and completeness are essential to ensure that patients receive the correct tests and timely results. Below are guidelines to follow:

• Do double-check the patient's personal information (name, date of birth) to prevent any mix-ups.
• Don't overlook the checkbox section that indicates patient status like fasting or non-fasting, as this can significantly impact test results.
• Ensure that the ICD 9 DIAGNOSIS CODE(s) are filled in correctly since Medicare coverage may depend on these codes.
• Do not leave the provider information section blank, including the UPIN/NPI#, name, and contact details. This information is crucial for follow-ups and result reporting.
• Do specify if a test needs to be expedited by marking the 'STAT' or 'ASAP' options, to prioritize urgent testing needs.
• Don't forget to indicate the correct test codes and descriptions under the appropriate sections (e.g., Hematology, Chemistry Profiles) to avoid incorrect test processing.
• Ensure all necessary checkboxes are marked, including those for therapeutic drug monitoring and the specific time for peak and trough levels, for accurate dosing and monitoring.
• Do not ignore the comments section for any critical information or specific instructions that might help in the analysis or processing of the lab tests.
• Always verify and sign the form before submission to confirm the requisition is approved by the attending physician and to validate the request.

Following these guidelines ensures that the processing of lab tests is efficient and error-free, facilitating better patient care and outcomes.

Many people have misconceptions about the Lab Requisition form, leading to confusion or errors when filling it out. Understanding these misconceptions is critical for accurate and efficient test ordering and processing. Below are four common misunderstandings and explanations to clarify them.

• Misconception 1: All routine screening tests are covered by Medicare. Medicare does not generally cover routine screening tests unless they are deemed medically necessary. The form specifically indicates that the provider must include ICD (International Classification of Diseases) codes, which justify the need for the tests to potentially obtain coverage.
• Misconception 2: Fasting is only required for certain tests. While it's true that fasted states are crucial for some tests, such as the lipid panel, the misconception lies in the uniformity of fasting requirements. Depending on the test, the duration without food or drink (except water) might vary. It is important to follow the specific fasting instructions, including the number of fasting hours, mentioned on the requisition form to ensure accurate results.
• Misconception 3: The form can only be used at Kaiser Permanente labs. Although it seems designed for Kaiser Permanente facilities, with mentions of specific Kaiser procedure codes, the essential information on the form, like tests ordered and patient data, is standard. Other laboratories can also process these requisitions, provided they offer the same tests. However, the unique laboratory identification and processing details that are Kaiser-specific may not be applicable elsewhere.
• Misconception 4: Any test can be ordered without prior approval. The form includes a section indicating that for any test not listed, a provider must call a specific number to order it. This points to a common misunderstanding that any test can be added to the form without obtaining necessary approvals or verifications, which is not the case. Approval might be required not only for insurance coverage but also to ensure the requested test is appropriate and available at the laboratory.

These clarifications aim to dispel common errors and improve the test ordering process, benefiting both healthcare providers and their patients.

Filling out and using a Lab Requisition form properly is crucial for ensuring accurate and timely test results, which are essential for diagnosing and monitoring patient conditions. Here are key takeaways to consider when handling this document:

1. Every section of the Lab Requisition form should be filled out with clear and accurate information to prevent any confusion or errors in the testing process.
2. The form requires the provider’s name, address, phone number, and fax number, which are vital for communication and results reporting.
3. Specifying the ICD 9 diagnosis code(s) is required because Medicare does not generally cover routine screening tests. This affirms the necessity of the tests from a medical standpoint.
4. Patient identification, including the last and first name, date of birth, and Kaiser Medical Record number when applicable, is crucial for accurately matching test results to the correct individual.
5. The selection of test urgency (e.g., STAT, ASAP, routine) and the patient’s fasting status are important for the laboratory to prioritize the sample processing and understand conditions that may affect the test results.
6. Providers must select the specific tests required for the patient, which can range from urinalysis and hematology to chemistry profiles and therapeutic drug monitoring, ensuring each selected test is clearly indicated to avoid any oversight.
7. The form includes sections for the date and time of the last dose for therapeutic drugs, which is critical for interpreting levels accurately.
8. "To order any other test, providers must call" indicates that while the form covers a wide range of tests, additional or special tests require direct communication with the laboratory.
9. Information regarding the draw site, number of sticks, and specimen types (e.g., SST, lavender, red, etc.) help in preparing and managing the sample collection process efficiently.

Attention to detail in completing the Lab Requisition form supports effective patient care by ensuring that the laboratory receives all necessary information to accurately perform and report test results.