Get Versiti Platelet And Neutrophil Immunology Requisition Form 2021-2025

Filling out the Versiti Platelet And Neutrophil Immunology Requisition Form online is crucial for ensuring accurate and efficient communication regarding platelet and neutrophil testing. This guide provides clear, step-by-step instructions to help users complete the form with ease.

Follow the steps to complete the requisition form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Begin by providing the details of the person completing the requisition. Fill in the fields for their name, institution, client number, department, physician or provider's name, and contact information.
3. In the patient information section, enter the patient's last name, first name, medical record number, accession number, middle initial, date of birth, and sex.
4. Indicate the draw date and time. If applicable, confirm if the patient is pregnant and provide the due or delivery date.
5. Complete the sections on the patient's medical history, including whether they have had an allogeneic stem cell transplant, blood transfusions in the last two weeks, and specify the type of specimen required.
6. List the necessary test orders based on the patient's condition. Ensure to check any boxes that apply and provide additional information if required.
7. For special reporting requests, fill in the purchase order number and any additional instructions necessary for processing.
8. Review all entered information for accuracy. After confirming correctness, users can save changes, download the completed form, print it for physical submissions, or share it as needed.

Complete the requisition form online to ensure timely processing of your laboratory requests.