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Get La Lab Form 96 2013-2026

Lab Form 96 Revision 09/2013 Lab Test Request Form VIROLOGY / IMMUNOLOGY BOLD PRINT INDICATES REQUIRED INFORMATION. INCOMPLETE INFORMATION MAY CAUSE SPECIMEN REJECTION. Patient Information First Name Last Name Middle Initial Date of Birth / Address City State Zipcode Parish Marital Status Gender Race Divorced Widowed Male AI - American Indian/Alaskan Native AP- Asian Pacific Married Unknown Female BL - Black/African American MR - More than One Separated Other PI - Pacific Islander/Native Hawaiian OT - Other WH - White/Caucasian UK - Unknown/Unreported Hispanic Single Medicaid Number Chart Number Medical Provider Name Bayou Health Plan Name Bayou Health Identification Number Clinic Type or OPH Code For test information see www. lab. dhh. louisiana.gov or email questions to oph. publichealthlab la.gov Specimen Information Influenza Real Time RT-PCR Hepatitis B Mumps Vaccination Date Respiratory Virus Panel Hepatitis B Immunization Dengue Risk Factors Norovirus GI and GII Orthopox Arbovir....

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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.

  1. Click the ‘Get Form’ button to retrieve the LA Lab Form 96, making it accessible for you to fill out.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. 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.
  7. 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!

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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.

Required information on a lab requisition includes the patient's name, the type of test ordered, and the ordering physician's details. Additionally, important demographic information and insurance details should be present. The LA Lab Form 96 provides a structured way to collect this information, greatly enhancing workflow efficiency.

A lab request form contains the patient’s identification details, the tests being requested, and the ordering doctor’s information. It may also include medical history or symptoms relevant to the requested tests. The LA Lab Form 96 is designed to ensure all these necessary components are included, streamlining the process for both patients and providers.

Lab requisition forms require comprehensive patient identification, the specific lab tests ordered, and the ordering provider's information. It's also essential to include any clinical information that might aid in interpretation. Utilizing the LA Lab Form 96 enhances clarity and compliance with these vital details.

To successfully complete a requisition form, you need the patient's full name, date of birth, the tests requested, the healthcare provider's name, and any relevant insurance information. Each of these elements plays a critical role in ensuring accurate lab results. The LA Lab Form 96 encompasses all these requirements, making it the preferred choice.

A requisition form typically requires the patient's name, date of birth, and contact information. Additionally, the healthcare provider's details and the specific tests requested should be clear. For optimal use, integrating the LA Lab Form 96 can simplify the process by ensuring all necessary fields are present.

A laboratory requisition should include the patient's personal information, the tests that need to be performed, and the provider's details. It’s essential to capture any special instructions or clinical background that may assist the lab. The LA Lab Form 96 helps ensure that all necessary data is accurately documented.

When filling out a laboratory request form, include patient identification details, the requested tests, and any pertinent clinical notes. You should also ensure that signatures or authorizations are clearly stated. The LA Lab Form 96 helps maintain organization, so nothing crucial is overlooked.

A request form typically requires the patient's name, date of birth, and insurance details, along with any relevant medical history. It also needs the provider's name and signature for authorization. Using the LA Lab Form 96 can make it easier to ensure all required information is present.

A laboratory request form must include the patient’s demographics, medical history, and the specific tests being requested. Additionally, it should have the healthcare provider's information, including contact details. The LA Lab Form 96 ensures all essential information is captured for accurate lab processing.

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