Get Bn 1396-01 Laboratory Request Form - Boone Hospital Center

Filling out the BN 1396-01 Laboratory Request Form online is a straightforward process that requires accurate input of patient and test information. This guide will provide clear steps to ensure users can complete the form efficiently and correctly.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the 'Patient' section, entering the patient’s full name, date of birth, address, and contact information. Ensure the information is accurate for proper identification.
3. In the 'Account Information' section, specify whether the bill should go to the client or the patient/insurance. Provide details such as account number if relevant.
4. Fill out the 'Ordering Physician' information, including the physician's name and contact details. This ensures that the laboratory can reach out for any clarifications.
5. Next, provide relevant insurance information by indicating the type of insurance, including policy numbers and the name of the insurance company.
6. Complete the 'Specimen Collection' section by indicating the date and time of collection, as well as the ordering physician's signature.
7. In the sections requesting test orders, select the necessary tests by marking the boxes next to the test names and providing any required reason codes.
8. Review all the information entered for accuracy, ensuring that all specifications are met, including any additional comments or specifics underneath the test fields.
9. Finally, after ensuring the form is complete, save changes to the document, and choose to download, print, or share it as needed.

Start filling out your Laboratory Request Form online to streamline your process.