Get Laboratory Outpatient Requisition - Brazosport Regional Health ... - Brazosportregional

Completing the Laboratory Outpatient Requisition form is essential for ensuring proper medical testing and efficient billing. This guide provides you with clear, step-by-step instructions to help you fill out the requisition accurately and confidently online.

Follow the steps to fill out the requisition form online effectively.

1. Click ‘Get Form’ button to acquire the form and open it for completion.
2. Begin by entering the patient’s name in the designated fields: Last Name, First Name, and Middle Initial. Ensure that all entries are accurate before proceeding.
3. Fill in the patient’s date of birth, age, and sex (select M for male, F for female).
4. Complete the order date and time of collection. Specify whether the test is routine, urgent, or stat by marking the appropriate box.
5. Provide the responsible party’s name and address for billing purposes, along with their Medicare and Medicaid/HMO numbers, as applicable.
6. In the testing section, clearly mark or write in the desired test(s) and include the appropriate ICD-9 diagnosis codes for each one.
7. Ensure that any additional reports needed are directed to the correct address by filling in the associated fields.
8. Review all sections to confirm that at least the shaded portions are filled out completely.
9. Once all information is entered, save your changes. You may also choose to download, print, or share the requisition form as needed.

Complete the Laboratory Outpatient Requisition form online today for efficient processing of your medical testing needs.