Get Ejgh Outpatient Lab Order Form

Filling out the Ejgh Outpatient Lab Order Form online can streamline the process for both patients and healthcare providers. This guide will walk you through each section of the form to ensure all necessary information is accurately provided.

Follow the steps to complete the Ejgh Outpatient Lab Order Form online.

1. Press the ‘Get Form’ button to acquire the form and open it in your document editor.
2. Enter the order date in the designated field.
3. Provide the patient's Social Security number in the corresponding box.
4. Select the patient's insurance company from the list or type it in as needed.
5. Print the patient's full name, including last, first, and middle names.
6. Input the member or insured ID number in the relevant section.
7. Fill in the patient's address, including city, state, and zip code.
8. Attach a copy of the insurance card if required, as indicated on the form.
9. Print the physician's name in the provided field.
10. Specify the patient's date of birth.
11. Indicate the patient's sex in the designated area.
12. Provide both home and work phone numbers.
13. Check any applicable options such as 'STAT' or 'Fasting' if needed.
14. Enter the fax number to which the results should be sent.
15. Select the appropriate tests from the lists provided, ensuring all relevant panels and options are marked.
16. Input any ICD-9 diagnosis codes in the designated area.
17. Include the physician's phone number and address.
18. Ensure the physician’s signature is placed in the required section.
19. Confirm all fields are filled out accurately and completely.
20. Save changes, then download, print, or share the completed form as necessary.

Complete your documentation online to ensure a smooth and efficient order process.