Follow the steps to complete the Test Requisition form online.

1. Click ‘Get Form’ button to access the Test Requisition form and open it in the editor.
2. Enter the patient information in the designated fields. Fill out the patient's last name, first name, and middle initial, if applicable. Include the date of birth (D.O.B.), address, city, state, zip code, and telephone number. Ensure that the social security number is accurately entered.
3. Indicate the patient's gender by selecting either 'Male' or 'Female'. If applicable, provide the responsible party or subscriber information and mark the relationship to the patient, such as 'self', 'child', 'spouse', or 'other'.
4. Select the billing information option that applies, such as 'Bill Patient', 'Bill Client', 'Bill Medicare', 'Bill Medicaid', or 'Bill Insurance'. Include the necessary insurance details like Medicare and Medicaid numbers, if applicable.
5. Fill out the ICD-9 diagnosis code(s) for tests ordered, ensuring that it corresponds to the diagnosis/sign and symptom in the correct format.
6. Provide the physician or provider's information, including their name, location, and telephone number. Record any specific requests concerning test result reporting, such as whether to call or fax the results.
7. Indicate if fasting is required by selecting 'Yes' or 'No'. If the test is deemed STAT (urgent), mark the 'STAT' checkbox as appropriate.
8. Finally, ensure all information is complete and accurate. After making sure all sections are filled out, save the changes, and then you can download, print, or share the Test Requisition form as needed.

Complete your Test Requisition form online today for efficient specimen processing.