Get Drug Test Request Form

Filling out the Drug Test Request Form online is essential for ensuring accurate and efficient therapeutic drug monitoring. This guide provides a step-by-step approach to help you complete the form correctly and seamlessly.

Follow the steps to effectively complete your Drug Test Request Form.

1. Click ‘Get Form’ button to access the Drug Test Request Form and open it in an editor.
2. Begin by entering the clinical centre information, including the Lab21 ID, the requesting doctor's name, hospital or clinic, and contact details such as telephone, fax, and email.
3. In the patient information section, affix the clinic label and fill in the required fields: hospital/clinic number, weight, patient ID, height, sample ID, viral load, and date of birth. Include the CD4 count if applicable.
4. Specify the sample to be tested, ensuring to indicate the sample type (plasma only) and complete the date taken field. List the constituent drug(s) to be analyzed and tick the box if is included.
5. Fill in the dosage information, including dose and time taken, as well as the dosing frequency options. Include time elapsed since the last dose, ensuring to mark any applicable options.
6. If the patient is receiving fixed dose combination therapy, make sure to detail the individual constituent drugs in the designated table, if necessary.
7. In the other antiretroviral therapy section, indicate any additional information if applicable.
8. Select the reason for therapeutic drug monitoring by ticking more than one option if needed, such as pregnancy, dialysis, possible drug interaction, or suspected toxicity.
9. Provide any additional comments that may aid in the assessment or process.
10. After completing all sections, review the entered information for accuracy. Save changes to the form, and then proceed to download, print, or share the form as needed.

Start filling out your Drug Test Request Form online today for efficient therapeutic monitoring.