Get Litholink Request Form

The Litholink Request Form is essential for initiating 24-hour urine testing for kidney stone analysis. This guide will provide clear steps to assist you in completing the form accurately and efficiently.

Follow the steps to fill out the Litholink Request Form online.

1. Press the ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the physician's last name and first name in the designated fields. Ensure accuracy as this information is crucial for processing the request.
3. Enter the date of birth for both the physician and the patient in the respective sections.
4. Provide complete details under the physician information section, including the physician's street address, city, state, zip code, and office/physician phone number.
5. In the patient information section, enter the patient's last name, first name, gender (M/F), last four digits of the social security number, and the medical record number (MRN), which will appear on the report.
6. Select the appropriate diagnosis from the options provided, ensuring to comply with the ICD-CM format for the highest specificity.
7. For cystine urine panels, choose only one panel required for patients with known cystinuria.
8. Specify whether you want one or two 24-hour collections for kidney stone urine panels and ensure that all necessary tests are marked.
9. Complete the section on serum/blood collection location by selecting either a LabCorp Patient Service Center or physician’s office/hospital.
10. Indicate any special instructions for handling, if applicable, to ensure proper processing of the samples.
11. Fill in the shipment delay for the At-Home kit if there are specific requests. Select your preferred option for obtaining the At-Home kit.
12. Click on the option to receive a confirmation phone number and address for any questions or concerns.
13. Review all sections of the form for completeness and accuracy before submitting.
14. Once all information is filled out correctly, save changes, download the form, or print it as needed. Share the completed form as required, especially with your healthcare provider.

Complete your Litholink Request Form online today to facilitate timely analysis and treatment.