Get Kaizer Permanente Community Provider Laboratory Order Form 2020-2025

This guide provides clear and comprehensive instructions for users on how to effectively fill out the Kaizer Permanente Community Provider Laboratory Order Form online. By following these steps, users can ensure that all necessary information is accurately captured for laboratory services.

Follow the steps to complete the form online accurately

1. Click the ‘Get Form’ button to obtain the Kaizer Permanente Community Provider Laboratory Order Form and open it for editing.
2. Fill in your UPIN or NPI number in the designated field at the top of the form. Ensure that you provide the correct number to avoid processing issues.
3. Enter the patient's name in the specified format: Last, First. Make sure to double-check the spelling for accuracy.
4. Provide the provider's name in the corresponding field. Ensure the name is legible and includes any necessary suffixes.
5. Complete the address field with the provider's current practice address, ensuring it is accurate and up-to-date.
6. Input the date of birth for the patient along with a secure fax number where the order can be sent.
7. Fill in the Kaiser Permanente health record or member ID number of the patient, as this is necessary for identification.
8. Provide the patient's phone number for any follow-up communications that may be required.
9. Specify the ICD-9 diagnosis code(s) relevant to the test requested. This is important for insurance processing.
10. Indicate whether the patient is non-fasting or the number of fasting hours prior to the test as applicable.
11. Select the urgency of the order by checking 'ASAP' if necessary.
12. Ensure you have the provider's signature and date at the bottom of the form to validate the order.
13. Review all entered information for completeness and accuracy before submission.
14. Once all sections are filled out, save changes to your form. You may then download, print, or share the form as needed.

Start completing your laboratory order form online today to enhance your workflow and ensure timely testing.