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

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

Test Requisition Form Patient Information: Name: Date of Birth: / / Sex: Address: Medical Record #: FILTER PAPER # : Male Female Daytime Telephone #: ( ) - Date Sample Collected: / / Hospital/Lab.

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How to fill out the Test Requisition Form Testing Ordered (please Check) - PerkinElmer online

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.

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A requisition initiates the request for a specific action and also records that action for subsequent reporting needs. For example, employees within a company would use a purchase requisition if they needed additional supplies.

What is the Purpose of a Requisition Form? Requisition forms, sometimes called referral forms, are used by your doctor or local physician to communicate precisely what type of exam you require for a medical assessment.

DNA Quantity: Incoming genomic DNA samples should contain at least 5 µg of DNA per sample at a concentration of ≥ 100 ng/µL. PerkinElmer recommends the use of Picogreen fluorometry when determining the quantity of each sample. Samples must be provided in 50 µL – 100 µL of molecular biology grade water or TE buffer.

The test requisition combines patient registration information, billing information, specimen information, barcoded specimen labels and a provider order for confirmation of testing. The patient bill requisition should be completed by the provider or authorized staff and signed by the ordering provider.

ORDER FORM / REQUISITION A requisition form must accompany each sample submitted to the laboratory. This requisition form must contain the proper information in order to process the specimen. The essential elements of the requisition form are: Patient's surname, first name, and middle initial.

A test requisition form is used by healthcare professionals to request laboratory tests such as urine or blood testing.

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