Get Outpatient Blood Product Order Form - Wellspan Lab Services - Wellspanlabs

Filling out the Outpatient Blood Product Order Form is a crucial step in ensuring patients receive the appropriate blood product during their outpatient treatment. This guide provides a clear, step-by-step approach to help users accurately complete the form online.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Provide the patient's full name, date of birth, sex, and either their Social Security Number or Medical Record Number, making sure all required fields marked with an asterisk (*) are completed.
3. Fill in the patient's address and additional information, such as the physician’s name for an additional copy of the form.
4. Enter the name of the physician ordering the tests, ensuring that it is printed clearly. The physician must also sign and print their name.
5. Input the name of the individual who collected the specimen, along with the date and time of collection.
6. Attach the necessary insurance information to the form as required.
7. Select and fill in the appropriate diagnosis codes (ICD9) that correspond to the tests needed.
8. Check the relevant blood bank routine orders and specify details for each test related to packed red blood cells, platelets, plasma, and cryoprecipitate as applicable.
9. Provide details regarding the number of units and any special requirements for the blood product being ordered.
10. Supply indications for the transfusions as necessary, making sure all applicable selections are marked.
11. Review the form for completeness and accuracy, making sure all sections are filled out correctly.
12. Once completed, you can save changes, download, print, or share the form according to your needs.

Complete your Outpatient Blood Product Order Form online today to ensure efficient and timely patient care.