Get Standing Order Request Form

Filling out the Standing Order Request Form online is a straightforward process that ensures your order is submitted efficiently. This guide will help you understand each component of the form and provide step-by-step instructions for completion.

Follow the steps to efficiently complete the Standing Order Request Form online.

1. Click ‘Get Form’ button to obtain the Standing Order Request Form and open it in your preferred editor.
2. Enter the account name in the designated field. This ensures your submission is linked to the appropriate client records.
3. Fill in the NSLS account number, which helps in identifying your specific account for billing purposes.
4. Provide the physician's name who is initiating the standing order. This is crucial for maintaining proper communication and accountability in patient care.
5. Indicate if this is a one-time order request or a standing order request. Select the appropriate option based on your needs.
6. Complete the patient details by filling in the patient's name, date of birth, and address. Ensure accuracy to avoid complications.
7. Specify the patient's gender in the appropriate field.
8. In the billing information section, specify if the client or the patient will be billed and provide the relevant test code and test name associated with the services requested.
9. If applicable, include Medicare and NorthShore IPA details as well as the ICD-9 code to ensure proper billing and insurance submission.
10. Add any additional copies required for distribution by listing the fax number or anyone else who needs a copy.
11. Fill out the effective date and expiration date for the standing order. Remember that standing orders generally expire twelve months from the order date unless specified otherwise.
12. Define the frequency of the orders, whether they occur weekly, monthly, or at another interval.
13. Finally, ensure that the physician's signature is added to validate the order.
14. Once you have filled out the form completely, you can save your changes, download the form for your records, print it for physical submission, or share it as needed.

Complete your Standing Order Request Form online today for efficient processing.