Get Ui Health Care Microbiology Laboratory Requisition 2020-2025

This guide provides clear and supportive instructions for users on how to complete the UI Health Care Microbiology Laboratory Requisition online. By following these steps, you can ensure that all necessary information is accurately submitted for laboratory testing.

Follow the steps to successfully complete the requisition form.

1. Click ‘Get Form’ button to access the requisition and open it in your preferred editor.
2. In Part A, enter the patient's information. This includes the patient’s last name, first name, street address, city, state, zip code, phone number, fax number, date of birth, and gender.
3. Move to Part B to provide the provider's information. Fill in the referring institution's name, address, phone number, and fax number, as well as the referring physician's name and their phone number.
4. Proceed to Part C and detail the specimen information. Fill in the specimen collection date and time. You are also required to enter the applicable ICD-10 codes.
5. Indicate the type of specimen being collected by checking the relevant boxes, which may include blood, urine, stool, and others. Specify additional details where necessary.
6. List the tests requested under the cultures section. Select any relevant tests and include further information or clinical history as necessary.
7. In Part D, indicate who the bill should be sent to, whether it is the referring institution or the patient's insurance, and provide the required policy information.
8. Lastly, ensure all information is filled in accurately, and save your changes. You can now download, print, or share the completed requisition form.

Complete your requisition form online now to ensure efficient processing of your laboratory tests.