Get Clinical Test Requisition Form - Ct

Filling out the Clinical Test Requisition Form - Ct online is a straightforward process that ensures accurate and efficient laboratory testing. This guide provides step-by-step instructions to help users complete the form effectively.

Follow the steps to fill out the Clinical Test Requisition Form online.

1. Click ‘Get Form’ button to obtain the form and open it in your chosen editor.
2. Begin by entering the patient's information in Section 1. Fill in the patient's name, street address, city, state, and zip code. Provide the date of birth and select the gender. Indicate the home phone number and check all applicable race options, as race/ethnicity information is required for specific testing.
3. Continue in Section 1 by indicating any recent international travel by selecting 'Yes' or 'No' and specify the locations if applicable. Additionally, provide the ordering healthcare provider's name and phone number.
4. In Section 2, provide the specimen information. Enter the submitter sample ID and the date and time the sample was collected. Choose the appropriate specimen source/type from the list provided.
5. For Section 3, select the tests requested. Review the options under bacteriology, bacterial serology, virology, and parasitology, and check all that apply. If the required test is not listed, specify it in the provided space.
6. Finally, review all the information entered for accuracy. Once satisfied with the completed form, save changes, download the document, print it, or share it as needed.

Complete your Clinical Test Requisition Form online today for streamlined testing!