Get Hetl Blood Lead Test Requisition Form( Pdf ) - Maine

This guide aims to assist users in accurately completing the HETL Blood Lead Test Requisition Form in an online format. By following these steps, individuals can ensure that all necessary information is provided for the blood lead testing process.

Follow the steps to successfully complete the requisition form

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the submitter's name, address, and phone number in the designated fields at the top of the form. Ensure that all information is accurate and legible.
3. Provide the submitter's fax number, along with the hospital or laboratory ID number, to facilitate any necessary communications.
4. Next, fill in the physician's name and their practice or affiliation. This information identifies the medical professional responsible for the blood lead test.
5. In the patient section, enter the patient's last name, first name, and middle initial, ensuring all names are spelled correctly.
6. Select the patient's gender by marking the appropriate box.
7. Input the patient's date of birth using the provided date fields and ensure that the format is correct.
8. Provide the patient's street address, including any apartment number, city/town, state, zip code, and county.
9. If the patient has MaineCare insurance, include the MaineCare number in the respective field. Also, provide the name and phone number of the parent or guardian.
10. Indicate the specimen type/source by selecting the relevant option. For blood tests, select between venous or capillary. If applicable, check if the test is symptomatic or a repeat test.
11. Refer to the instructions on the reverse side of the form for information on specimen handling, storage, and shipping.
12. Once all fields are completed, review the form for accuracy. Make any necessary corrections.
13. Finally, save the changes, download the completed form, or print and share as required.

Complete your HETL Blood Lead Test Requisition Form online today to ensure prompt processing.