Get Semen Analysis Laboratory Requisition

Filling out the semen analysis laboratory requisition accurately is essential for effective laboratory testing. This guide provides a clear and supportive approach to completing the form online, ensuring that you have everything you need for a successful submission.

Follow the steps to complete your requisition form online.

1. Click ‘Get Form’ button to access the requisition form and open it in your preferred online editor.
2. Begin by entering the patient's name, including their last and first name, in the designated fields.
3. Input the physician’s name, ensuring that both the last and first names are filled out accurately.
4. Complete the social security number and date of birth fields for the patient as required.
5. Provide the phone number and fax number for the patient, ensuring that the information is current.
6. Fill out the partner's name section, providing both last and first names.
7. Have the physician sign in the designated field to verify their authorization.
8. Indicate the identity verification method and date of collection accurately.
9. Record the driver's license number and the number of days of abstinence since the last ejaculation.
10. Specify the receiving technologist, time collected, and the accession number for the specimen.
11. Choose between on-site or off-site collection site and indicate if this is a post-vasectomy sample.
12. Select the collection method used and whether the sample collected is complete or incomplete.
13. Indicate the sperm source to clarify whether it is ejaculatory, epididymal, or testicular.
14. Check the appropriate laboratory tests requested, such as complete semen analysis, sperm cryopreservation, or fertility-related testing.
15. Ensure that both the patient and partner/spouse signatures are provided, along with their social security numbers.
16. After completing the form, save your changes, and proceed to download, print, or share the document as needed.

Complete your semen analysis laboratory requisition online today for efficient processing!