Get Test Requisition Form Testing Ordered (please Check) - Perkinelmer

Filling out the Test Requisition Form Testing Ordered (please Check) from PerkinElmer online is a straightforward process. This guide provides detailed instructions to help you correctly complete each section of the form, ensuring all necessary information is submitted for testing.

Follow the steps to complete the Test Requisition Form with ease.

1. Press the ‘Get Form’ button to access the form. This action will allow you to open the document in your preferred online editing environment.
2. Enter the patient information in the designated fields. This includes the patient's full name, date of birth, sex, and address. Ensure that all entries are accurate and up to date.
3. Provide the medical record number and filter paper number in the relevant sections. This information is crucial for tracking and managing the patient's laboratory results.
4. Fill in the daytime telephone number and the date the sample was collected. This ensures that the laboratory can contact you if there are any questions regarding the sample.
5. Specify the testing ordered by checking the appropriate boxes. This list includes comprehensive newborn screenings and expedited processing, as well as various DNA screens.
6. If applicable, list any current medications, relevant lab tests, and suspected diagnosis. This information is important for interpreting test results accurately.
7. Indicate the patient's ethnic background, if required for interpretation of DNA screens, and any relevant family history.
8. Provide the requesting physician's information, including name, address, and contact details. This section must also include the physician's signature.
9. Input the billing contact's address and phone number. Ensure to state whether the invoice should be sent to the physician or if prepayment will be made through other means.
10. Once all sections are filled out accurately, save the changes made to the form. You can then download, print, or share it as necessary for submission.

Complete your Test Requisition Form online today to ensure timely processing of laboratory tests.