Get Dlo Order Form

Filling out the Dlo Order Form online is a straightforward process designed to help healthcare providers obtain necessary laboratory reports for their patients. This guide will walk you through each section of the form, ensuring that you provide all required information for a successful request.

Follow the steps to complete the Dlo Order Form.

1. Click the 'Get Form' button to access the Dlo Order Form and open it in your browser.
2. In the 'Treating Provider' section, enter your details: first name, middle name, last name, phone number, and address. Ensure you include your DLO account number and NPI number, if applicable.
3. Fill out the 'Patient's Information' section by entering the patient's name, phone number for daytime and evening contact, gender, date of birth, and address. The last four digits of the social security number and insurance ID number are optional but may assist in identifying records.
4. Provide the 'Laboratory Information Requested', including the test(s) performed, date(s) of service, and the ordering physician's details such as their name, phone number, and address.
5. In the 'Treating Provider's Signature' section, sign and date the form. This signature confirms your request for the laboratory to search their electronic records for the patient's information.
6. Review all filled fields to ensure accuracy and completeness. Incomplete requests may be denied.
7. After ensuring all information is correct, you can save changes, download, print, or share the form as needed.

Complete your Dlo Order Form online today for efficient processing of your laboratory requests.