Get Requisition Form - Advanced Medical Laboratories

Filling out the Requisition Form for Advanced Medical Laboratories is a crucial step in ensuring proper testing and processing of medical specimens. This guide will walk you through each section of the form, providing clear instructions tailored to help users navigate the online process effectively.

Follow the steps to complete the requisition form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the patient’s information section. Enter the last name, first name, and middle initial of the patient as they appear on their identification. Include the patient's sex, social security number, and date of birth in the specified format (MM/DD/YY).
3. Provide the patient's identification number if applicable, followed by the physician's or provider's name. Ensure you indicate the collection time, selecting either AM or PM, and confirm if the patient is fasting by checking 'Yes' or 'No'. Fill in the collection date in the MM/DD/YY format.
4. Enter the facility name and obtain the physician's or provider's signature in the designated field. Then, describe the patient’s symptoms or diagnosis using ICD-9-CM codes, ensuring the highest specificity.
5. Complete the insurance information by filling in the primary billing party details, including the insurance carrier, state, group number, and address. Provide the name of the insured person and their relationship to the patient.
6. If there is a secondary billing party, fill in similar information as done for the primary billing party. Make sure all necessary fields are completed for an accurate and efficient billing process.
7. Ensure the patient’s address is entered accurately. The patient should authorize the release of medical information related to the services by signing in the provided space, along with the date.
8. Review the custom panel options and check any applicable tests that need to be conducted. Be mindful of the codes linked to each test, as they will be required for processing.
9. Once all fields are completed and verified, save changes to the form. Options to download, print, or share the form can usually be accessed from the toolbar in the editor.

Complete your requisition form online today for efficient processing of medical tests.