Loading
Get La Lab Form 96 2013-2025
How it works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
How to fill out the LA Lab Form 96 online
Filling out the LA Lab Form 96 online can streamline the submission process for lab test requests. This guide provides step-by-step instructions to help you navigate each section of the form with ease.
Follow the steps to complete the LA Lab Form 96 online.
- Click the ‘Get Form’ button to retrieve the LA Lab Form 96, making it accessible for you to fill out.
- Begin by entering the patient information in the specified fields. This includes the first name, last name, middle initial, date of birth, address, city, state, zip code, parish, marital status, gender, race, and hispanic status. Note that bold print indicates required fields—ensure they are fully completed to avoid specimen rejection.
- Next, provide the Medicaid number and chart number, along with the medical provider's name, the Bayou health plan name, and the provider ID number. These details are essential for tracking and processing the request.
- Fill out the specimen information section. This includes selecting the relevant tests, such as Influenza Real Time RT-PCR or Hepatitis B. Specify the vaccination date and the date of collection, including the time of collection.
- Indicate the type and source of the specimen. Options include swab, blood, tissue, or other samples. Providing detailed information here will assist in accurate testing.
- In the submitter information section, enter the necessary details about the submitting facility, including the facility name, address, contact person, and their phone or fax number. This ensures that communication can be established if necessary.
- Once all sections are completed, review your entries for accuracy. Save any changes you've made and choose to download, print, or share the completed form as required.
Take the next step and complete your LA Lab Form 96 online today!
A patient's lab requisition form must include the patient’s name, contact details, the specific tests to be conducted, and the ordering provider's information. Including relevant clinical notes can also be beneficial. The LA Lab Form 96 serves as a comprehensive template that captures all these critical details efficiently.
Industry-leading security and compliance
US Legal Forms protects your data by complying with industry-specific security standards.
-
In businnes since 199725+ years providing professional legal documents.
-
Accredited businessGuarantees that a business meets BBB accreditation standards in the US and Canada.
-
Secured by BraintreeValidated Level 1 PCI DSS compliant payment gateway that accepts most major credit and debit card brands from across the globe.